Adoption Application. Your Name. Are you 21 years of age or older? Yes No. Address. City State Zip. Home Phone # Work # Cell #

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1 Wilson Animal Rescue Adoption Application Your Name Today s Date Are you 21 years of age or older? Yes No Address City State Zip Home Phone # Work # Cell # What is the best time to contact you? Type of home you live in: House Condo/Townhouse Apartment Do you have a yard? Front yard Back yard If so, is it securely fenced? Yes No How tall is your fence? Do you rent or own your home? Rent Own How long have you been at your present address? If you rent, please provide your landlord s name and phone number.

2 Name Phone # Do you have permission from your landlord to get a dog? Yes No Are you aware of pet deposit and monthly fees (if any) required? Yes No Including yourself, how many people live in your home? How many are under the age of 18? Please provide the ages of all children in your home. Interest Have you adopted a dog before? Yes No Are all in the household in favor of adopting a dog? Yes No If not, tell us which person and why (Example: Husband not in favor, we already have two dogs.) How long have you been looking for a dog? 1 month or less 2-4 months 4-6 months, 6 months or more Off and on in the past year Other

3 What is your family s lifestyle like? Active and on the go Quiet and relaxed Entertain frequently Lots of kids in and out Travel frequently Why did you decide to get a dog? What are you looking for in a pet? Who will be responsible for taking care of the dog? Which of our dogs are you interested in? What it is about this dog(s) that appeals to you? Are you aware of the financial obligations of owning a dog? Yes No A dog requires routine veterinary care. This includes but is not limited to a yearly vet exam and vaccinations. Will you provide this? Yes No Do you agree to obtain rabies vaccinations and records as required by law for this dog? Yes No

4 What conditions or circumstances would cause you to give up a pet? Current Pet Ownership How many dogs do you have living in your home/ on your property? How many cats do you have living in your home/ on your property? What other animals do you have? Are all of your pets spayed/ neutered? If not, why? Are all of your pets current on vaccinations and deworming? If not, why? Do any of your pets have any behavioral problems? List the age, breed, and sex of your other dog(s). List your prior pets and where they are now (another shelter, lost, deceased, living elsewhere, etc.)

5 Environment Where will your new dog spend its days? Where will your new dog spend its nights? How much time will your new dog be left alone daily? Where will your new dog be kept when no one is home? How will your new dog be exercised and how often? What behaviors of animals do you consider intolerable? (House soiling, jumping, barking, scratching, etc.) Are you willing to work with your dogs on any issues that it may have as it adjusts to your home and your current pets? Yes No References Who is your veterinarian? Name Phone # Agreements for Adoption: I am prepared to make a 10 to 15 year commitment to my dog. I will keep my dog on a regular routine of heartworm preventative.

6 I will provide flea/tick control as needed. I will work with my vet and agree on a regular schedule for wellness visits, inoculations, and any other tests we agree are necessary for the health and well- being of my dog, I will not chain or tie- up my dog and leave it outside along. My dog will be an indoor dog and an important member of my family. If, for any reason, I am unable or unwilling to keep this dog, I agree to return him/her to the Original Pet Owner. I will not give this dog away, take it to a shelter, place him/her with another person or family member, or sell this dog to any other person without the express permission of the original Pet Owner. I am financially able to provide routine and emergency care for this dog for his/her lifetime. This includes but is not limited to food, boarding (if necessary), regular vet care, heartworm preventative and flea and tick preventative. I HAVE ANSWERED ALL QUESTIONS AND PROVIDED ALL NEEDED REFERENCES TRUTHFULLY AND HONESTLY TO THE BEST OF MY KNOWLEDGE. I WILL DO MY BEST TO COMPLY WITH THE WILSON ANIMAL RESCUE. ADOPTION POLICIES, WHICH INCLUDE PROVIDING A LOVING AND SAFE ENVIRONMENT FOR THE LIFETIME OF MY NEW DOG. Printed Name: Signature: Date:

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