Date:
Interested in: Dog's Name:
2nd Choice:
Name:
Age of applicant:
Age of co-applicant:
Do you live with your parents?
Address:
City/State/Zip Code:
Home Phone #:
Cell Phone #:
Email Address:
Do you live in a: House
Apartment
Condo
Mobile Home
Other:
If renting, Landlord's name and phone number:
How long have you lived at present address?
The yard is: Completely Fenced
Partially Fenced
Not Fenced
No Yard
How high is your fence?
The fence is: Chain Link
Privacy Fence
Invisible Fence
If no fence, how do you plan on keeping your dog contained in the yard?
Are you adopting for: Yourself
Family
Gift/Surprise
Others:
Why do you want this dog? Companion
Child's Pet
Hunting
Gift
Guard/Watch
Other:
How many adults reside in your home?
Married
Fiance
Older-Children
Roommate
Parent
Other:
Number of Children:
Ages of Children:
Are all members of the household in agreement with adopting this pet?
Do any members of the household have any allergies?
If so, describe:
Who will be responsible for taking care of the pet?
What arrangements have you made to care for the pet in case you can no longer do so?
How many hours per day will this animal be left alone?
Where will the pet be kept when left alone?
List of all current Pets. Please include breed, name, age:
Are they up to date on vaccines:
Are they spayed/neutered:
Are they on Heartworm Prevenative:
List all previous Pets in the last 5 years. Please include breed, name, age:
Were they up to date on vaccines:
Were they spayed/neutered:
Were they on Heartworm Prevenative:
Does pet live inside/outside:
How long did you have your pet?
Why is pet no longer with you?
Who is your current/previous veterinarian? (List clinic name AND PHONE NUMBER. Please contact your vet clinic and give permission to release your pet's information.)
Are your current and previous pet listed under your name?
If no, please list name:
How much time do your current/previous pets spend outside?
Where will this dog be routinely living: Inside
Outside
If other, describe:
Rescue animals require time to adjust to their new home. What amount of time do you consider to be reasonable for adjustment?
There are costs involved in having a pet. The average cost of preventative veterinary care is $200-$500. Additionally there are expenses of food, toys, grooming, boarding, emergency vet care, etc. to consider, does your household budget allow you to comfortably cover these expenses?
How do you plan on exercising this dog?
Are you willing to enroll this dog obedience training?
If no, what are your plans for training this dog? (Be specific)
What behaviors would you be unable to tolerate from an adopted dog? (check all that apply) Potty Accidents
Jumping Up on Furniture
Playing in Early A.M. Hours
Barking
Getting Into Trash/Garbage Cans
Counter Surfing
Hiding From Guests/Other Family Members
shedding on Furniture/Clothing
Chewing
Escaping
Fighting
Digging
Biting
Inability To Get Along Wih Other Animals
Not Quickly Adjusting To Other Pets In The Home
Methods I plan to use to discourage un-wanted behaviors:
You understand that rescue dogs may have unknown medical history/problems?
You understand that rescue dogs may have unknown behavior issues?
Additional information you would like to provide to WAG:

The above information that I have provided to WAG Animal Rescue for the purpose of adopting an animal is accurate and complete.

Signature:
Date:
PO BOX 222 Wyandotte, MI 48192
Email: waganimalrescue@yahoo.com
Web Site: www.waganimalrescue.com