I understand the adoption/application process *

I Understand

Date / Time *

Date

Time

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

What Animal are you interested in (Name/Breed)?

If the dog you are interested in has already been adopted or is pending adoption, is there any other dog you may be interested in? *

Yes
No

How many people reside at your residence?

Please give names and ages. *

If just yourself please just type self.

1. (a) References a. Veterinarian’s Name and contact number: Please note we do not adopt to anyone who has not properly vetted their pets (Dogs, Cats etc.)

If you have not owned an animal before and therefore do not already have a veterinarian, please indicate by typing a brief explanation. Please Note: *Properly Vetting your pet means: You must take your pet to the Vet at least once a year, the pet must be up to date with all their vaccines, they must be spayed or neutered, all preventives your Vet recommends must be used example: Heart worm and Flea preventives etc., Checking teeth is essential for good health.

1. (b) List two (2) references NOT RELATED TO YOU, with Name and contact number: *(Must provided a 3rd reference if no Vet reference provided) *

2. (a) Do you currently own any other pets? *

Yes
No

2. (b) *(List species/breed, name/age of each and if neutered/spayed)

If not applicable please ignore.

3. Are your current dogs licensed for your township, village or city? *

Yes
No
Not Applicable

4. What type of dwelling do you live in (house/apartment/condo/)? *

5. (a) Do own or rent your home? *

5. (b). *(Renters: Please provide Landlord name and contact number)

6. (a) Is your yard fenced? *

Yes
No
N/A

6. (b) What type of fencing do you have?

If not applicable enter n/a

7. What traits/characteristics are you interested in for your pet? *

8. How will you train the animal (potty/leash/behavioral training)?

9. (a) Other animal concerns: a. How much alone time, will the pet have? *

9. (b) Where will the pet be kept when left alone? *

9. (c) Where will the pet sleep? *

9. (d) Will you be crating the pet? How long will the pet be crated each day/night? *

9. (e) How will you socialize the pet with other animals?

9. (f) How will you socialize the pet with new people?

9. (g) Would there ever be an occasion the pet will be allowed off a leash or out of a secured area? *

(Please describe when/why)

9. (h) Who will be the primary caretaker for the pet? *

9. (i) IF YOU ARE APPLYING TO ADOPT A PUPPY: Puppies need constant supervision and training and cannot be left alone for long periods of time. Have you made arrangements for the puppy to be cared for while you’re away or at work? (Puppy sitter/ puppy daycare, Family member, neighbor etc)?

Yes
No
Not Applicable

(* Please be prepared to give Names & phone numbers to your interviewer for anyone who will be helping to care for the puppy should you be approved to adopt.)

10. Are you financially sound to provide Veterinarian visits for vaccinations, heartworm testing, dental and physicals exams annually? a. * (Average Veterinarian visit many be greater than $100 in some states) *

Yes
No

11. Are you willing to adopt a pet that is older? *

Yes
No

12. Are you willing to adopt a pet that has been abused and may have behavioral problems such as fear biting/aggression? *

Yes
No

13. Are you willing to adopt a pet that requires continual housetraining? *

Yes
No

14. Are you willing to adopt a pet that is NOT reliable with children? *

Yes
No

15. (a) For what reason would you ever give up this rescue animal? *

15. (b) * (Whom would you surrender the animal to? *

If not applicable enter n/a

15. (c) Have you ever surrendered a pet? *

Yes
No

15. (d) If you have surrendered a pet who did you give them to and for what reason?

Please be advised that according to our adoption contract,, any of our former fosters who need to be surrendered will be sent back to Gertie’s Small Dog Rescue. Time must be given to find space in a foster home.

16. (a) Are you also applying to adopt a dog from another rescue or a shelter? (Yes or No) *

Yes
No

16. (b) If yes, please explain.

17. How did you hear about Gertie’s Small Dog Rescue? *

18. List any other helpful information:

I certify the information provided on this application is true and I understand the adoption terms as detailed in this application. *

(Type First and Last Name)

Gertie's Small Dog Rescue

Adoption Application

PLEASE READ OUR ADOPTION FEE SCHEDULE