ADOPTION APPLICATION FORM Please complete all required fields! APPLICANT INFORMATION Name* Invalid Input Street Address Invalid Input City Invalid Input State Invalid Input Zip Invalid Input Email* Invalid Input Evening Phone Invalid Input Cell Phone Invalid Input Employer Invalid Input Spouse/Partner’s Employer Invalid Input How did you hear about CHEW Dog Rescue? Petfinder/AdoptapetCHEW WebsiteOther Invalid Input Number and age of household members Men Invalid Input Ages Invalid Input Women Invalid Input Ages Invalid Input Boys Invalid Input Ages Invalid Input Girls Invalid Input Ages Invalid Input Are you expecting a child or planning a family in the near future? Invalid Input Are all your family members in favor of a rescue dog? YesNoInvalid Input If no, please explain Invalid Input Is anyone in your household allergic to dogs? YesNoInvalid Input If yes, please explain. Invalid Input Type of dwelling you live in: Select oneHouseCondo/Town houseMobile HomeDuplexOtherInvalid Input Do you own or rent? OwnRentInvalid Input If you rent, do you have the landlord’s permission to keep a dog? YesNoInvalid Input Dog size limitations? Invalid Input Name and phone number of your landlord: Invalid Input How long have you lived at your current address? Invalid Input Do you plan to move in the near future? Invalid Input Would you be willing to allow us to visit your home prior to adoption? YesNoInvalid Input Next > 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 Invalid Input Type of dog preferences, if any (size age range, gender, etc.) Invalid Input Would you consider a special needs dog? Invalid Input Why do you want to adopt a rescue dog; please identify all that apply CompanionshipWatch dogCompany for current petA gift for someoneInvalid Input 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? YesNoInvalid Input If no, please explain: Invalid Input < PrevNext > DOG ENVIRONMENTAL INFORMATION Is part of your yard fully fenced? YesNoInvalid Input What is the approximate size of the fully fenced yard? Invalid Input Height & type of fence Invalid Input If not fenced, will you fence it before you adopt a dog? Invalid Input Do you have a pool? Invalid Input If yes, is it securely fenced? Invalid Input How many consecutive hours a day are you away from home for work, school, etc? Invalid Input Do you plan to keep the dog primarily indoors or out? Please explain: Invalid Input Where will your dog sleep? If in the house, where in the house? Invalid Input Do you plan to use a crate for housebreaking, if needed, or while you are gone? Invalid Input How do you plan to exercise the dog(s)? Invalid Input What other activities do you plan to do with the dog? Invalid Input Where will your dog stay when you go on vacation? Invalid Input Do you plan to take your new adopted dog to obedience class? Invalid Input If no, please explain Invalid Input Who will be the primary caregiver for this dog? Invalid Input Please describe your training method, including your approach to eliminating undesired behavior. Invalid Input Please let us know what makes you an ideal candidate to adopt a rescue dog: Invalid Input For what reasons would you return a dog back to us? movingnot getting along with other petsgetting out of fencenew babydivorcehousebreaking problemsotherInvalid Input < PreviousNext > PETS, PAST AND PRESENT List all dogs you currently own Breed Age Male/Female Spayed/Neutered? Indoors or Outdoors Breed 1 Invalid Input Age 1 Invalid Input Male/Female1 Invalid Input Spayed/Neutered?1 Invalid Input Indoors or Outdoors1 Invalid Input Breed 2 Invalid Input Age 2 Invalid Input Male/Female 2 Invalid Input Spayed/Neutered? 2 Invalid Input Indoors or Outdoors 2 Invalid Input Breed 3 Invalid Input Age 3 Invalid Input Male/Female 3 Invalid Input Spayed/Neutered? 3 Invalid Input Indoors or Outdoors 3 Invalid Input Breed 4 Invalid Input Age 4 Invalid Input Male/Female 4 Invalid Input Spayed/Neutered? 4 Invalid Input Indoors or Outdoors 4 Invalid Input List All cats you currently own Age Male/Female Spayed/Neutered? Indoors or Outdoors Declawed? Age 1 Invalid Input Male/Female 1 Invalid Input Spayed/Neutered? 1 Invalid Input Indoors or Outdoors 1 Invalid Input Declawed? 1 Invalid Input Age 2 Invalid Input Male/Female 2 Invalid Input Spayed/Neutered? 2 Invalid Input Indoors or Outdoors 2 Invalid Input Declawed? 2 Invalid Input Age 3 Invalid Input Male/Female 3 Invalid Input Spayed/Neutered? 3 Invalid Input Indoors or Outdoors 3 Invalid Input Declawed? 3 Invalid Input Age 4 Invalid Input Male/Female 4 Invalid Input Spayed/Neutered? 4 Invalid Input Indoors or Outdoors 4 Invalid Input Declawed? 4 Invalid Input Other pets you currently own, please list: Invalid Input List any dogs you have previously owned: Invalid Input If you’ve had dogs in the past, where are they now? Invalid Input Have you ever given a dog up or had a dog for a brief period of time and it didn’t work out? Invalid Input If yes, please explain the circumstances Invalid Input How would you provide for your dog’s medical bills if they become expensive? Invalid Input < PreviousNext > 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 1 Invalid Input Reference Phone 1 Invalid Input Reference Relationship 1 Invalid Input Reference Name 2 Invalid Input Reference Phone 2 Invalid Input Reference Relationship 2 Invalid Input Reference Name 3 Invalid Input Reference Phone 3 Invalid Input Reference Relationship 3 Invalid Input Vet Reference (if you currently own pets or have in the recent past): Clinic name Invalid Input Clinic address Invalid Input Clinic phone Invalid Input Name of veterinarian: Invalid Input 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. I am over 18 years of age and information I have given above is true and complete.Invalid Input Name Invalid Input Date Invalid Input 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. < PrevSubmit
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