How did you hear about us? FaceBook Friend/Colleague Internet search Petfinder.com Critter magazine Other
If other, please specify:

Name(s):

Home street address: Apartment or unit number: City or town: State: Zip code:

Home/Contact phone:

Work phone:

Email address:

Age:

Occupation(s):

How long have you been at this address? years and months

Do you    own   or     rent?

If renting, please provide landlord's information:

Landlord's name:
Landlord's phone number:

Do you have the permission of your landlord to have a dog? Yes No

Are you interested in a particular dog? Yes No

If Yes, which one?

If No, what breed and size are your interested in?

Gender preferred: No preference Female Male

Age desired: No preference Puppy Adult Senior (9 yrs and older)

What are your reasons for wanting to adopt a dog at this time? (Check all that apply.)
Family Pet
Watch Dog
Companion for current pet
Other
Other (please explain below): _

Please share with us any special activities in which your new dog will be participating in as part of the family:
_

Do you have any children, currently expecting a child, planning for a child, or will children be visiting the home? Yes No

If Yes, please give their ages:

Who is the dog primarily for? Adult Child Elderly

Who will have chief responsibility for the care of your new pet?
_

Does anyone in your household have allergies to dogs? Yes No

Home visits are a required part of SBRET's adoption process, please give a time(s) that are best to conduct the visit.
_

Please list individually all pets you currently own and have previously owned within the last 15 years:

Pet #1 Name Breed Age Still living with you? Yes No

Pet #2 Name Breed Age Still living with you? Yes No

Pet #3 Name Breed Age Still living with you? Yes No

Pet #4 Name Breed Age Still living with you? Yes No

Pet #5 Name Breed Age Still living with you? Yes No

Pet #6 Name Breed Age Still living with you? Yes No

Pet #7 Name Breed Age Still living with you? Yes No

Pet #8 Name Breed Age Still living with you? Yes No

Pet #9 Name Breed Age Still living with you? Yes No

Pet #10 Name Breed Age Still living with you? Yes No

If the pets listed above are no longer living with you, please explain:
_
Where do your current pets stay during the day?

Where do your current pets stay at night?

Are your current pets:

Spayed/Neutered? Yes No
Up to date on vaccines? Yes No
On monthly heartworm prevention? Yes No

Have you ever had a pet run away? Yes No

If Yes, please explain:

Have you ever had to give up a pet? Yes No

If Yes, please explain:

Where will the new dog be during the day?

Where will the new dog be at night?

How many hours will this new pet be alone?

Is your yard fenced in?
   Yes  If Yes, what type and height?
  
   No   If No, please describe how you plan to monitor your dog when outside on your property:
  

Do you have a swimming pool? Yes No
If Yes, do pets have free access to the pool? Yes No

Where will the dog stay when you are on vacation or out-of-town?

If you move will your dog move with you? Yes No

What behaviors, if any, would cause you to give up your dog?

Please provide the full name of your current or most recent veterinarian:

Please provide the address of your current veterinarian:

Please provide the phone number including area code of your current veterinarian:

May we contact your vet for a reference? Yes No
    Please provide full name account is under:
    

Please provide the full name and phone number of a personal reference:

If you do adopt a rescue dog and decide to give it up, do you agree to contact us and make arrangements to get the dog back to SBRET?
       Yes No

Have you or any members of your family/household been cited for leash law violations or cruelty to animals in the past?
       Yes No
       If Yes, please explain:
      

Have you applied to any other Rescue groups? Yes No

If yes, please identify the group so that we do not duplicate their efforts:

I/We attest that the Terms and Conditions of the Adoption Application as stated below have been read in full and I/We understand that said terms and conditions are part of the adoption process and will be enforced.         Yes No

  I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge.

  I/We attest that we understand that completion and submission of this application does not in any way guarantee adoption of an SBRET Rescue Animal.

  I/We understand that any misrepresentation of fact may result in the removal of the adopted dog from my/our home.