Online Adoption Application – Road Home Rescue

The Road Home Rescue Adoption Application

Please understand, rescuing a dog from our organization is not for everyone. We are very selective when it comes to finding the right home for each and every dog we save. Just because you are interested in a particular dog does not mean that he/she is a good match for you.

"*" indicates required fields

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Fullname:*

First Middle Last

Address:*

Street Address City State / Province / Region ZIP / Postal Code

Type Of Residence:*

House

Condo

Townhome

Apartment

Mobile Home

Other

Do you:*

Own

Rent

Other

Main Phone:*

Alt Phone:

Email:*

How long have you lived at your current address?*

Do you have plans to move in the near future?*

Yes

If yes, location:

DOG PREFERENCES

If you are interested in a particular dog(s) from our current list, please list names:

*Sex of Dog:*

Male

Female

Either

Desired weight when fully grown:

Small

Medium

Large

No Preference

Do you have a preference for the COLOR of your dog?

Do you have a preference for the AGE of your dog?

Alternate size, weight, color preferences – please describe:

Who is the dog for?*

Have you ever owned a dog before?*

Yes

If no, have you done research on this breed?

Yes

What traits of this dog especially appeal to you?*

Have you ever owned this breed of dog before?*

Yes

If yes, what happened to them?

Why do you want to own a dog?*

What expectations do you have for this dog?*

Please describe any specific traits you are looking for in an adoptive dog:*

Why would you choose a rescue over a breeder?*

From your perspective, what are the pros and cons of owning a dog?*

Are there any circumstances under which you would give up a dog? Please explain.*

Have you ever given away, sold or surrendered a dog before and why?*

Have you ever been charged with animal or child abuse?

Yes

If yes, when? (mm/dd/yy)

HOME ENVIRONMENT

Explain the pet policy where you live (i.e. any covenants, restrictions, pet deposits, etc.)*

*Do you have a fenced-in yard?*

Yes

If yes, note the approximate size of the fenced area, and height and type of fencing material.

Where will the dog be kept when you are not at home?

Approximately how many hours of the day will the dog be alone?*

Where will the dog be kept during the day?*

Where will the dog sleep at night?*

What type of exercise do you plan to give this dog?*

Who will have primary responsibility for the care of your dog?*

Number of adults in household?*

Number of kids? Please list ages of all children:*

Do you have any cats?*

Yes

Please list all animals currently living in your household:

Name:

Type:

Age:

Sex(M or F):

Spayed/Neutered(Y or N):

Time Owned:

Kept(Inside or Outside:

VET ENVIRONMENT

Do you have a veterinarian you have used before and/or plan to use with your new dog?*

Yes

If yes, please provide name, address and phone number:

Are your pets current on all vaccinations, rabies shots, heartworm and fecal tests?*

Yes

*Are your pets current on heartworm preventative?*

Yes

Date of last vet visit (mm/dd/yy):

MM slash DD slash YYYY

Note: We will contact your veterinarian to verify that all current pets are up-to-date on vaccinations. Unless there is a good reason, we will not adopt to persons with unvaccinated or unaltered animals.

Have you and your family discussed the pros and cons of owning a dog?*

Yes

Do you and your family understand that owning a dog requires a lot of energy if the dog is to be properly cared for?*

Yes

Do you and your family understand that a dog requires a 10 to 15 year commitment?*

Yes

Are you willing to take your dog to obedience training?*

Yes

Are you willing to consult a trainer or behaviorist if problems develop?*

Yes

Are you willing to use a crate (portable cage) as a housebreaking and transitional aid?*

Yes

Do you realize that costs of pet ownership (food, toys, heartworm and flea prevention, and vet fees) are approximately $600 - 1,000 per year?*

Yes

Are you financially prepared to give your dog the routine medical care it requires? (Heartworm preventative, annual booster shots, annual check-up, etc.)*

Yes

AUTHORIZATION

Please read each statement carefully and check the box to show that you understand.

I understand that completing an application does not mean that I will be able to adopt a dog from The Road Home Rescue.

I understand that there will be an adoption fee for the dog, which will be used to partially offset the veterinary expenses incurred by TRH.

I understand that all rescue dogs are spayed or neutered before adoption. A rescue dog will not be bred.

I am able to afford regular (at least annual) veterinary care and heartworm preventative for the dog, as well as emergency care, if needed.

I understand that any inaccurate or incomplete information can be reason for refusal.

I understand that a rescue dog has already suffered the loss of at least one family. I will support TRH's efforts in facilitating that the next home is a permanent one by allowing TRH to:

1. Interview me

2. Discuss my current and previous pets and their care with my vet

3. Make a scheduled visit to my home to inspect fences and other areas where the dog will be kept.

Is there any other information that you wish to call to our attention? (If so, please enter that information below.)

Application submitted by:

Volunteer (if not submitted by applicant):

Next STEPS

Your application will be submitted and we will reach out to you after reviewing.

Name

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