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Dog Adoption Application

Please fill out the application as complete as possible, as it gives us a better chance to find the best pet match for you. Fields with an * are required.

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone*

Email*

Employer

Occupation

Have you paid the $5 nonrefundable application fee?
Yes. Thank you!
No.
(Please send $5 to our venmo, paypall, or rescue website. Why is there an application fee? The application fee has been implemented to make sure everyone applying is making a thoughtful decision before applying to adopt a new pet. This fee also goes directly towards supporting the many animals in our care right now. Payment of the application fee is required prior to application processing.)

Name of dog you are interested in:

1. How many people currently reside in your household?

2. Are there any children in your household?
Yes
No

Please provide age of children

3. For whom are you adopting the dog?
Self
other

4. Does any member of the family have any allergies to animals?
Yes
No

If you answered yes, please explain.

5. Who will be responsible for the dog's care?

Name

6. What type of residence do you live in?
Apartment
Condo
Farm
Mobile Home
Townhouse
Single-Family House
Other

If you checked other or wish to elaborate on your type of residence, please explain below.

7. Do you rent or own your residence?
Rent
Own

If you rent, please provide the name and phone number of your landlord.

8. Are pets allowed at your residence?
Yes
No
Not Sure

9. Where will your dog spend most of his/her day when you are home?
Indoors Free Roaming
Indoors in a Crate
Outdoor Kennel
Outdoor - Fenced Yard
Indoor/Outdoor Freedom (Doggie Door)

10. Where will the dog spend most of his/her day when you are NOT home?
Indoors Free Roaming
Indoors in a Crate
Outdoor Kennel
Outdoor - Fenced Yard
Indoor/Outdoor Freedom (Doggie Door)

11. Tell us about your yard. Check all that apply:
I do not have a yard
Backyard with no fence
Yard with fence

12. Will anyone be home during the day?
Yes
No

13. How many hours a day will the dog be left unattended?

14. If you move, what will you do with the dog?

15. Have you ever had a companion animal (pet) before?
Yes
No

18. Are your pets up to date on their core vaccinations?
Yes
No

16. Describe the pets you still care for or that are living in your household.

K9/Feline/Other	Name	Age	Neutered/Spayed	Kept Where	Time in your care

Any additional pets?

17. Describe the pets you no longer care for.

K9/Feline/Other	Name	Age	Neutered/Spayed	Kept Where	Time in your care	Reason no longer with you

Any additional pets you no longer care for?

Cheyla's Rescue Policy: In order to be approved these vaccines need to be up to date. *If not up to date, you can discuss with a coordinator as we understand some pets are medically unable, too young, etc.

Dogs: Required: DHPP, Rabies and Bordetella, yearly heartworm test, up to date on Flea/Tick and Heartworm prevention. Strongly Recommended: Leptospirosis, Lyme and Influenza.

Cats: Required: FVRCP and Rabies. Recommended: FeLV, Heartworm/Flea/Tick prevention

19. Who is your currrent Veterinarian?

Name

Phone

20. Are all pets in the household (dogs and cats) spayed/neutered?
Yes
No

If no, please explain.

21. Are you financilly able and willing to provide annual checkups, vaccinations, and ANY medical care necessary?
Yes
No

22. What precautions would you take to properly introduce a new dog into your home if you have other animals (a dog, bird, rabbit, cat, etc)?

23. What will you do if your new dog does not get along with your present pets?

24. Do you understand that it may take a couple months for your new dog to get used to your current pets?
Yes
No

25. Have you ever adopted an animal from a rescue/animal control agency?
Yes
No

26. Have you ever had an application rejected for adoption of an animal from a rescue/animal control facility?
Yes
No

If yes, please explain.

27. Why do you want to adopt a dog?

28. If a disciplinary or behavior problem arises, what steps will you take to remedy it?

29. Are you familiar with your local animal control laws?
Yes
No

30. Are you willing to sign legal pet adoption papers?
Yes
No

31. Do you agree to permit a visit to your residence by appointment, if necessary?
Yes
No

Do you have any questions or have any information you'd like us to know?

By signing this form, I/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact may result in Cheyla's Rescue Foundation refusing adoption privileges to me/us. If my/our request for adoption is approved and later Cheyla's Rescue Foundation discovers the above information is not true or correct, Cheyla's Rescue Foundation reserves the right to remove the adopted cat/dog from my residence and assume custody of the pet. By signing this form, I am confirming that I am at least 18 years old or older.

Signature*

Date