Small
Dog Rescue
ADOPTION
APPLICATION
Purebred
& Mixed Breed
(ALL DOGS ARE SPAYED OR NEUTERED)
All
Questions MUST Be Answered, Unless Indicated as “Optional.”
Incomplete
Applications Will Be Rejected!
Email your completed application to: application@tikiblackdog.org
________________________________________________________________________________
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): _____________________________
________________________________________________________________________________
CERTIFICATION
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: ______
MAKE SURE ALL QUESTIONS HAVE BEEN FULLY
ANSWERED
BEFORE
SUBMITTING YOUR ADOPTION APPLICATION.
Please Email Your Completed Application
to: