Small Dog Rescue


Purebred & Mixed Breed



All Questions MUST Be Answered, Unless Indicated as “Optional.”

Incomplete Applications Will Be Rejected!


Email your completed application to:



First & Last Name: ________________________________________________________________

Address: ________________________________________________________________________

City: _________________________State:_____________________Zipcode:__________________

Home Phone: __________Cell Phone (if applicable): __________Work Phone (optional):_________

Email Address: ___________________________________________________________________

Best Manner & Time to Contact You: ________________________________________________
Employment Status: Employed _____ Retired _____ Other (explain) _________________________

Ages & Number of Adults in Your Home – Fill in All Categories That Apply (below):

21-25: _____                                                 56-65: _____

26-35: _____                                                 66-75: _____

36-45: _____                                                 76-85: _____

46-55: _____                                                 86+:    _____

First & Last Names of Other Adults (21 and over) Living at Your Residence: ___________________ ________________________________________________________________________________

Number of Children & Persons (under 21) in Your Home (including visitors) ____________________

What Kind of Dog Are You Looking For: ________________________________________________

What Activity Level in a Dog Are You Looking For - Very Active, Moderately Active or Low Level of Activity: _________________________________________________________________________

Have You Had Dogs Before: __________ If So, What Type(s)/Breed(s):_______________________ ________________________________________________________________________________

What Happened to Your Dogs: _______________________________________________________


Did You Previously Have Any Other Pets: _____ If So, What Happened to Them: _______________


Will Your Dog Primarily Be an Indoor or Outdoor Dog: _____________________________________

Do You:  Own Your Home _____ Rent _____ Other (explain): _______________________________

Type of Residence(s) (Check Applicable Response(s) Below):

House _____ Apartment _____ Condo/Townhouse _____ Mobile Home _____

Other _____ (Explain) _____________________________________________

Years at Current Address: _____

Do You Have a Doggy Door: _____ If Not, Would You Install One: ___________________________

Do You Have a Fenced Yard: _____ If So, What Type of Fencing: ___________________________

Do You Have a Pool: _____ If So, Is It Also Fenced: _____

Have You Discussed This Adoption With All Members of Your Household: _____

How Do the Other Members of Your Household Feel About Adopting a Dog: ___________________


How Many Hours Per Day Will Your Dog be Left Alone: ____________________________________

When You Travel, or Go On Vacation, What Will You Do With Your Dog: ______________________

List Any Other Pets/Animals in Your Home/Household: ____________________________________ ________________________________________________________________________________

Do You Have a Regular Veterinarian: _____

If Yes, Provide Name & Phone Number of Your Veterinarian: __________________________

Do You Have a Regular Groomer: _____

If Yes, Provide Name & Phone Number of Your Groomer: _____________________________

A Dog Can Live for 15 Years or More – Are You Ready to Make That Kind of Commitment: ________

Any Other Additional Information You Wish to Include (optional): _____________________________



I certify that I am at least 21 years of age.  I understand that a dog can live for 15 or more years and I am ready to make that commitment and to provide proper food, water, shelter, health and other necessary care to any dog that I adopt from Small Dog Rescue for the adopted dog’s lifetime.  I further agree to notify Small Dog Rescue, should I become unable to fulfill any portion of my adoption commitment to them. I hereby verify that the information I have provided in this Adoption Application is true and accurate. I also understand that Small Dog Rescue reserves the right to refuse adoption for any reason.

Certify:   I agree: ______ I disagree: ______





Please Email Your Completed Application to: