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Jack's Animal Rescue

Jack's Place, Inc.

 

Adoption Application



Personal Information:

Name: 

Street Address:     City:     State:     Zip: 

Phone (include area code):    Home:        Work:     Mobile: 

Email:

References: 

Veterinary Reference (Name, Address and Phone Number): 

(If you've never owned a dog, list the names, addresses and phone numbers of two persons who've seen you interact with a dog. By submitting this form you are authorizing us to check your references.) 

Your Pet History: 

Reason for wanting a dog/cat? 

If applying for a dog, will the dog be a house pet?     Yes   No

If applying for a dog, will you use the dog for hunting?  Yes      No

Please list all pets owned in the last 10 years?  What happened to them?

Pet's Name            Type of Pet        Age        What happened to it

Your Household: 

List all family members and ages, especially children (Include yourself and anyone living or visiting overnight regularly in the house where the dog will live):

   Name                             Age         Relationship

 Is anyone in your family allergic to animals?   Yes  No

 Describe your home:  (condo/apartment, townhouse, single family home, etc.)    Own   Rent

 What is your occupation?      What is your spouse's occupation? 

Dog Knowledge & Commitment:

 Will you let the dog off-leash when walking?  Yes   No

Are you aware rescue dogs need time to adjust to a new home (up to a month when accidents may occur)? Yes    No

Are you prepared to spend time housetraining?  Yes  No

 What method of housebreaking will you use: 

Will you do obedience training? Yes  No

Will you take professional training classes?   Yes   No     Explain:

The Dog's Life:

Is anyone home during the day? Yes  No

If not, how long will the dog have to be alone?

If no one is home during the day will someone take time off when the dog first comes? Yes  No

Explain. 

 

 Where will the dog live during the day and at night?   

Will the dog be crated?  Yes   No       Explain:

Do you have a fenced yard?  Yes    No   What material is the fence made of and how tall is the fence?

Are you prepared to deal with special health issues if the dog needs special care later in life?  Yes   No

Explain:

What do you consider the limitations to providing health care for the older dog? 

Do you intend to be a multiple dog household?  Yes  No 

If Yes, how many dogs do you intend to have in your home?   

 The Why and Wherefore:  

Are you interested in a particular animal?  Animal's Name: 

Why are you interested in a particular animal?

Are there any deal breakers for your new pet?  (i.e., gets along with cats, good with kids, good watch dog, or doesn’t bark)

Additional comments or questions: