Dog Adoption Application

Adoption

Adoption form information fields

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Default: Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
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Country
Home Phone Number
Work Phone Number
Cell Phone Number*
- Preferred Method of Contact*
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Employment & Schooling
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Are You Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Name of Employer
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How Long Employed There?
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Are You in School?*
- Yes
- No
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Full or Part Time?*
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Previous Experience with Dogs*
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How Did You Hear About Us?*
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What Is Your Friend's Name?
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Which Shelter?
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Which Rescue?
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Please Describe
Dogs
Do You Now or Have You Ever Had a Dog?*
- Yes
- No
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Adults
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Are There Other Adults In The Home?
- Yes
- No
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How Many?*
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Adult 1
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First Name*
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Last Name*
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Age Range*
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Age*
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Gender*
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Relationship To Applicant*
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Previous Experience with Dogs*
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Please Describe*
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Phone Number*
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eMail Address*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Name of Employer*
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How Long Employed There?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Adult 2
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First Name*
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Last Name*
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Age Range*
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Age*
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Gender*
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Relationship To Applicant*
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Previous Experience with Dogs*
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Please Describe*
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Phone Number*
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eMail Address*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Name of Employer*
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How Long Employed There?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Adult 3
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First Name*
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Last Name*
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Age Range*
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Age*
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Gender*
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Relationship To Applicant*
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Previous Experience with Dogs*
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Please Describe*
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Phone Number*
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eMail Address*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Name of Employer*
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How Long Employed There?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Adult 4
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First Name*
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Last Name*
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Age Range*
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Age*
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Gender*
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Relationship To Applicant*
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Previous Experience with Dogs*
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Please Describe*
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Phone Number*
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eMail Address*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Name of Employer*
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How Long Employed There?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Children
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Are There Children In The Home?*
- Yes
- No
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How Many?*
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Child 1
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Name*
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Age*
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Gender*
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Previous Experience with Dogs:*
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Child 2
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Name*
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Age*
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Gender*
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Previous Experience with Dogs:*
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Child 3
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Name*
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Age*
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Gender*
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Previous Experience with Dogs:*
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Child 4
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Name*
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Age*
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Gender*
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Previous Experience with Dogs:*
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How Many?*
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Have you ever taken care of a dog before (ie dog walker, dog sitter, etc) or have any other dog experience?*
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Please Describe*
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Dog 1
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Dog's Name*
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Where Did You Get The Dog?*
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Please Explain*
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Is Dog Still Living With You?*
- Yes
- No
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Which Years Owned?*
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How Long Did You Own Him/Her?*
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Why not?*
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Why was dog euthanized?*
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Please Describe The Situation*
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Please Describe The Situation*
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Please Describe*
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Breed*
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Age Range*
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Gender*
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Status*
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Please Explain Why Not*
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Sociability*
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Sleeping Quarters*
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Up To Date on All Vaccines?*
- Yes
- No
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Vaccinated Annually?*
- Yes
- No
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Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
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Is There Any Additional Information You Would Like to Add?
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Dog 2
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Dog's Name*
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Where Did You Get The Dog?*
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Please Explain*
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Is Dog Still Living With You?*
- Yes
- No
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Which Years Owned?*
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How Long Did You Own Him/Her?*
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Why not?*
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Why was dog euthanized?*
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Please Describe The Situation*
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Please Describe The Situation*
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Please Describe*
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Breed*
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Age Range*
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Gender*
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Status*
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Please Explain Why Not*
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Sociability*
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Sleeping Quarters*
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Up To Date on All Vaccines?*
- Yes
- No
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Vaccinated Annually?*
- Yes
- No
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Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
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Is There Any Additional Information You Would Like to Add?
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Dog 3
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Dog's Name*
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Where Did You Get The Dog?*
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Please Explain*
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Is Dog Still Living With You?*
- Yes
- No
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Which Years Owned?*
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How Long Did You Own Him/Her?*
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Why not?*
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Why was dog euthanized?*
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Please Describe The Situation*
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Please Describe The Situation*
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Please Describe*
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Breed*
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Age Range*
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Gender*
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Status*
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Please Explain Why Not*
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Sociability*
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Sleeping Quarters*
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Up To Date on All Vaccines?*
- Yes
- No
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Vaccinated Annually?*
- Yes
- No
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Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
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Is There Any Additional Information You Would Like to Add?
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Dog 4
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Dog's Name*
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Where Did You Get The Dog?*
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Please Explain*
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Is Dog Still Living With You?*
- Yes
- No
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Which Years Owned?*
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How Long Did You Own Him/Her?*
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Why not?*
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Why was dog euthanized?*
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Please Describe The Situation*
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Please Describe The Situation*
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Please Describe*
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Breed*
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Age Range*
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Gender*
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Status*
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Please Explain Why Not*
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Sociability*
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Sleeping Quarters*
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Up To Date on All Vaccines?*
- Yes
- No
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Vaccinated Annually?*
- Yes
- No
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Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
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Is There Any Additional Information You Would Like to Add?
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Other Pets
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Are There Other Pets In The Home?*
- Yes
- No
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How Many?*
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Other Pet 1
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Pet's Name*
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Animal Type*
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Sleeping Quarters
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Sociability
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Is There Any Additional Information You Would Like to Add?
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Other Pet 2
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Pet's Name*
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Animal Type*
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Sleeping Quarters
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Sociability
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Is There Any Additional Information You Would Like to Add?
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Other Pet 3
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Pet's Name*
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Animal Type*
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Sleeping Quarters
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Sociability
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Is There Any Additional Information You Would Like to Add?
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Other Pet 4
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Pet's Name*
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Animal Type*
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Sleeping Quarters
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Sociability
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Is There Any Additional Information You Would Like to Add?
Residence
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Type of Residence*
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Please Describe Type of Residence
Do You Own or Rent?*
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Does Landlord Allow Dogs?*
- Yes
- No
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Are There Any Breed Or Size Restrictions?*
Please Provide Landlord's Name*
Please Provide Landlord's Phone Number*
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Yard Information
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Do You Have A Yard?*
- Yes
- No
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Is The Yard Fenced?*
- Yes
- No
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How High Is The Fence?*
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What Is The Lowest Point of The Fence?*
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What Material Is The Fence Made From?*
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Please Describe Fence Material*
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Is The Lawn Treated?*
- Yes
- No
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Do You Have A Pool?*
- Yes
- No
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Is The Pool Completely Fenced?*
- Yes
- No
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Family & History
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What Type Of Household Do You Have?*
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Please Describe*
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Do All Family Members Want A Dog?*
- Yes
- No
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Please Explain Who Doesn't and Why They Don't*
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Is Any Member Of Your Household Allergic To Dogs?*
- Yes
- No
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Does Any Member Of Your Household Smoke?*
- Yes
- No
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Are You WIlling To Take Responsibility For This Dog For The Next 10-15 Years?*
- Yes
- No
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What Provisions Will You Make For The Dog Should You Become Unable To Care For Him/Her?*
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Are You Capable of Providing Timely Healthcare?*
- Yes
- No
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What Are You Willing/Able To Spend On Annual Vet Care?*
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Please Explain Your Circumstances*
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Feeding & Exercise
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Who Will Be Responsible For Feeding The Dog?*
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Do You Plan On Walking Your Dog Daily?*
- Yes
- No
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Who Will Be Responsible For Walking The Dog?*
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What Other Means of Exercise Do You Plan On Providing The Dog?*
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Sleep & Alone Time
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Where Will The Dog Sleep?*
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Where Will The Dog Be When Alone?*
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Please Describe Where The Dog Will Be*
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Do You Have A Doggie Door?*
- Yes
- No
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Is It Locked When You Are Away From Home?*
- Yes
- No
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If You Are Gone From Home During The Day, Does Someone Let Your Dogs Out?*
- Yes
- No
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What Is The Longest Time The Dog Will Be Alone (without humans)?*
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Who Will Care For The Dog While You Are On Vacation?*
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Please Explain Who Will Care For The Dog*
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Behavior & Training
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Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Dog Comfortable In Your Home?*
- Yes
- No
What Behaviors Can You Tolerate (and work on)?
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Needs Social Skills*
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Accidents In The House*
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Inappropriate Chewing*
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Excessive Barking*
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Digging*
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Separation Anxiety*
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Other
- Yes
- No
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Please Explain Other Behaviors You Cannot Tolerate*
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What Are Your Plans For Training Your New Dog?*
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Please Describe Your Training Plans*
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Personal Reference
Please Provide A Personal Reference
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Please Provide Reference's First Name*
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Please Provide Reference's Last Name*
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Please Provide Reference's Phone Number*
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Please Provide Reference's eMail Address*
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Relationship to Applicant*
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Years Acquainted*
Veterinarian Information
Have You Used A Veterinarian Before?*
- Yes
- No
Please Provide Veterinarian's Name*
Please Provide Veterinarian's Phone Number*
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Trainer Information
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Have You Used A Trainer Before?
- Yes
- No
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Please Provide Trainer's Name
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Please Provide Trainer's Phone Number
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Groomer Information
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Have You Used A Groomer Before?
- Yes
- No
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Please Provide Groomer's Name
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Please Provide Groomer's Phone Number
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Boarding Facility Information
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Have You Used A Boarding Facility Before?
- Yes
- No
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Please Provide Boarding Facility's Name
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Please Provide Boarding Facility's Phone Number
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Reason For Adoption
Select all that apply.
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Family Companion*
- Yes
- No
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Personal Protection*
- Yes
- No
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For Child*
- Yes
- No
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Gift*
- Yes
- No
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Companion For Current Dog*
- Yes
- No
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Replace A Previous Dog*
- Yes
- No
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Other*
- Yes
- No
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Please Describe Reason For Adoption*
Would You Consider:
Fostering While Waiting For The Perfect Dog?*
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A Mixed Breed Dog?*
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Two Dogs?*
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A Dog That Can Be An Only Pet?*
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A Dog That Is Afraid Of Small Children?*
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A Dog That Needs Medications?*
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A Dog That Has A Serious Health Condition?*
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Please Select All Health Condition(s) You Would Accept*
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A Dog Who Needs Training For A Behavior Issue?*
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Please Select All Behavior Issue(s) You Would Accept*
Select All That Apply:
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A Dog that Has Special Needs?*
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Please Select All Special Needs(s) You Would Accept*
Select All That Apply:
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A Dog That is Not Completely Housebroken?*
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Select Gender*
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Select Age Range*
Select All That Apply
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Select Personality*
Select All That Apply
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Select Color*
Do You Have A Preferred Dog?*
Note: This does not guarantee this dog will be placed with you
List Other Dogs You Are Interested In
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When Will You Be Ready To Adopt?*
Is There Anything Else You Would Like to Let Us Know?
I am interested in receiving pet related services and products*
- Yes
- No
Authorization
Authorization:*
All of the information that I have given is true and complete. The dog will reside in my home as a pet. I will provide it with food, water, training, affection and routine veterinary care including monthly preventatives. I also understand that I must be 21 years of age to adopt. Your typed and signed signature signitifies that your have answered as honestly as possible and agree to our terms and conditions. Any answers found to be untruthful now or later, may result in loss of the dog, any court costs incurred to return the dog are the responsibility of the adopter. A representative of Field of Dreams Rescue has the right to refuse any application.*
- I agree
Email
This field is for validation purposes and should be left unchanged.

Dog Adoption Application

Adoption

Employment & Schooling

Dogs

Adults

Adult 1

Adult 2

Adult 3

Adult 4

Children

Child 1

Child 2

Child 3

Child 4

Dog 1

Dog 2

Dog 3

Dog 4

Other Pets

Other Pet 1

Other Pet 2

Other Pet 3

Other Pet 4

Residence

Yard Information

Family & History

Feeding & Exercise

Sleep & Alone Time

Behavior & Training

What Behaviors Can You Tolerate (and work on)?

Personal Reference

Please Provide A Personal Reference

Veterinarian Information

Trainer Information

Groomer Information

Boarding Facility Information

Reason For Adoption

Would You Consider:

Authorization

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