Welcome to CHEW Dog Rescue

ADOPTION APPLICATION FORM

APPLICANT INFORMATION

Name*
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Street Address
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City
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State
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Zip
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Email*
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Evening Phone
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Cell Phone
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Employer
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Spouse/Partner’s Employer
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How did you hear about CHEW Dog Rescue?
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Number and age of household members (please include all)
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Are you expecting a child or planning a family in the near future?
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Are all your family members in favor of a rescue dog?
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If no, please explain
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Is anyone in your household allergic to dogs?
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If yes, please explain.
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Type of dwelling you live in:
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Do you own or rent?
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If you rent, do you have the landlord’s permission to keep a dog?
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Dog size limitations?
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Name and phone number of your landlord:
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How long have you lived at your current address?
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Do you plan to move in the near future?
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Would you be willing to allow us to visit your home prior to adoption?
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INFORMATION ABOUT THE KIND OF DOG YOU WOULD LIKE TO ADOPT

Name of the specific CHEW Dog Rescue dog you are interested in, if applicable
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Type of dog preferences, if any (size age range, gender, etc.)
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Would you consider a special needs dog?
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Why do you want to adopt a rescue dog; please identify all that apply
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Are you willing to return the dog to CHEW Dog Rescue if, due to unforeseen circumstances you no longer are able to keep the dog?
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If no, please explain:
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DOG ENVIRONMENTAL INFORMATION

Is part of your yard fully fenced?
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What is the approximate size of the fully fenced yard?
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Height & type of fence
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Do you have a pool?
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If yes, is it securely fenced?
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How many consecutive hours a day are you away from home for work, school, etc?
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Do you plan to keep the dog primarily indoors or out? Please explain:
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Where will your dog sleep? If in the house, where in the house?
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Do you plan to use a crate for housebreaking, if needed, or while you are gone?
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How do you plan to exercise the dog(s)?
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What other activities do you plan to do with the dog?
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Where will your dog stay when you go on vacation?
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Do you plan to take your new adopted dog to obedience class?
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If no, please explain
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Who will be the primary caregiver for this dog?
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Please describe your training method, including your approach to eliminating undesired behavior.
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Please let us know what makes you an ideal candidate to adopt a rescue dog:
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For what reasons would you return a dog back to us?
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PETS, PAST AND PRESENT

List all dogs you currently own

Breed Age Male/Female Spayed/Neutered? Indoors or Outdoors
Breed
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Breed
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Breed
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Breed
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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List All cats you currently own

Age Male/Female Spayed/Neutered? Indoors or Outdoors Declawed?
Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Declawed?
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Declawed?
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Declawed?
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Age
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Male/Female
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Spayed/Neutered?
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Indoors or Outdoors
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Declawed?
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Other pets you currently own, please list:
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Describe the breed(s) and size(s) of any previously owned dogs:
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If you’ve had dogs in the past, where are they now?
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Have you ever given a dog up or had a dog for a brief period of time and it didn’t work out?
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If yes, please explain the circumstances
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How would you provide for your dog’s medical bills if they become expensive?
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REFERENCES

List three references that can attest to your suitability as a pet owner and, more specifically, the owner of a rescue dog.

Name Phone Relationship
Reference Name
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Reference Phone
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Reference Relationship
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Reference Name
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Reference Phone
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Reference Relationship
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Reference Name
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Reference Phone
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Reference Relationship
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Vet Reference (if you currently own pets or have in the recent past):
Clinic name
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Clinic address
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Clinic phone
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Name of veterinarian:
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Please let your veterinarian know that someone from CHEW Dog Rescue will be calling and that he/she has your permission to answer our questions.

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Name
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Date
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Information you submit on this form is kept confidential and used only for the purpose of considering your interest in adopting a CHEW Dog Rescue dog.