Dogz In Need

   Michelle Johnson: Affiliate of Rescue Alliance of Hairless & Other Breeds, Inc. 501(c)3

Valley Center, CA 92082   email: Dogzinneed@yahoo.com 

(760) 390-8973  www.DogzInNeed.RescueGroups.org 

  ADOPTION APPLICATION

 Adopter Screening Information:

Name _____________________________________ Driver’s License ____________________

Address ____________________________________City / State / Zip ____________________

Home Phone __________________  Cell Phone _________________ Email _______________

 Which dog are you interested in : __________________________________________________

 REFERENCES:

Employer: _________________________________ Work Phone:________________________

Address:   ____________________________________________________________________

City /  State /  Zip:______________________________________________________________

Personal Reference: _______________________________ Phone:_______________________

 Questionnaire:

1. Why are you considering adding a pet to your life? (check all that apply)

 2. How many people reside in your household?  _______________

 3. If you have children what are their ages and also the age of the people in the houseold ?  __________________

 4. Do all members of the household want a pet?            _  Yes  _  No

 5. Do any family members have allergies or asthma?       _  Yes  _  No 

 6. Will this animal be given as a gift?                            _  Yes  _  No

 7. Have you ever owned pets before?                         _  Yes  _  No

8.     If yes, how long did you have your pet? _____________________

9.     If pet(s) is no longer with you, what was the situation of their passing or absence
and have you ever gave a pet away :

        ______________________________________________________________________

10. What other pets live with you?

   Dogs (s) ___________  Breed(s) _____________________________________________

   Ages(s) ____________ Sex (s) ____________ Spayed/Neutered? _  Yes  _  No

   Cats (s) ___________  Ages(s) _________ Sex (s) ________  Spayed/Neutered? _  Yes  _  No

   Any other pets? _______________________________________________________________

11.  Do you own or rent your home? __________________________________________________ 

12.  Do you have a yard?  _  Yes  _  No           If yes, is it fenced?     _  Yes  _  No  _  Partial.   Height _____

13.  Do you have a pool?  _  Yes  _  No           If yes, is it secure?     _  Yes  _  No  _ Partial.   Height _____

14.  Where will your new pet be when you are not home?

   _ Indoors    _ Outdoors   _ Other ________________________________________________

15.  If your pet will be outdoors, will he/she be chained or tied up in any way?   _  Yes  _  No

16.  One average, how many hours will your pet be alone? _______________________________

17.  Do you have the time and knowledge and commitment to train your new pet should behavior concerns arise?  _  Yes  _  No

18.  Pets are an addition to the family, as such will require investment of your time and money for medical care, grooming, proper diet & water, proper shelter, exercise and protection from harm.  Are you willing and able to provide the appropriate resources that your new pet requires?     _  Yes  _  No

       Veterinarian Reference:  Name / Address _________________________________________________________

19. If arrangements do not work out with your new pet, are you willing to return it? 
 _  Yes  _  No

        (Please contact Dogz in Need with up to one week’s notice for return, to allow us time to find a foster home)

 _______________________________________                              ______________

Signature of Adopter                                                 Date

_______________________________________                              __________________

Name of Rescue Representative                                Date