A2Z Rescue Inc. Dog Adoption Application

	Based in South Yarmouth, Massachusetts E-Mail: A2ZRescue@yahoo.com Fax: 1-702-548-6824	Online Adoption Application
"Thank you for your interest in helping a dog have a second chance at life."
Please read this before you apply.

1.) Adoption or Fostering Preferences

I am interested in:

Please enter the name of the dog you are interested in*:

2.)*In Case of Adoption: Just in case the dog you were interested in has already been adopted or promised to someone else, please fill out the following information. We may still be able to match you up with another furry friend!

What breed would you be most interested in adopting?
What sex would you be interested in adopting?
What age dog are you most interested in adopting?

The oldest dog you would be willing to adopt would be:
Would you be willing to accept a dog with some health problem?
Would you be willing to accept a dog with some behavior problem?

3.) Personal Information

* Indicates a required field
First Name *:
Last Name *:
Address 1 *:
Address 2:
City *:
State *:
Zip Code *:
E-Mail*:


Home Phone *:
About Your Employment *:
Employer Name: (If applicable)
Work Phone: (If applicable)
Best Time to Call?:
Personal Reference NOT Related to You*:
Personal Reference Phone*:
Personal Reference E-Mail:

4.) About Your Home

* Indicates a required field
Type of home *:
If you rent, does your lease allow dogs? *
Landlord's Name:
Landlord's Phone:
Length of time at current address *:
Do you have a swimming pool? *	Yes No
Marital Status:
What are the ages of the adults in your home?*:
If there are children in your family, what are their ages? * (Check all that apply)	No children Middle School Under 1 year Junior High Toddler High school Grade school College


Is your yard fenced? *	Yes No
Fence Height in Feet:
Type of fence:
If you don't have a fence, how will you provide toileting & exercise for a dog?

5.) Your Plans if You Adopt/Foster a Dog

* Indicates a required field

Where will the dog be when you are home during the day? *
(Check all that apply)

Loose Indoors	Crate
Kennel Run
Loose Outside in Fenced Yard
In the Basement
Tied/Chained Outside
In a Garage
Other

Where will the dog be when you are away during the day? *
(Check all that apply)

Loose Indoors	Crate
Kennel Run
Loose Outside in Fenced Yard
In the Basement
Tied/Chained Outside
In a Garage
Other

How many hours per day would the dog spend alone? *

Where will the dog sleep at night? *
(Check all that apply)

Loose Indoors	Crate
Kennel Run
Loose Outside in Fenced Yard
In the Basement
Tied/Chained Outside
In a Garage
Other

How do you plan to discipline this dog?*

Do you plan to attend obedience classes with this dog?*

Yes No

If you decided to move, what would you do with this dog?*

If you could not keep this dog for any reason, would you return it to A2Z? *

Yes No

6.) Your Pet Ownership History

	* Indicates a required field
Do you currently have any pets?*	Yes No
Please list any other pets names, breeds, sex and ages:
Are all your other pets spayed or neutered?*
If your pets are not spayed, please tell us why:
How many pets have you owned in the past 5 years?*
If any of the pets in the last 5 years are no longer with you, please tell us why:
If you have had a pet die while in your home, please tell us what happened:


Have you ever given a pet up for adoption, or put a pet to sleep*?	Yes No
If you answered yes, please provide details:
Veterinarian for Reference*:
Veterinarian Phone*:
Prior Veterinarian:
Prior Vet's Phone:
Is there anything else you'd like us to know about you:

To see a printable version of this application, please click here.
-- If this application is incomplete, please be aware that you will probably recieve an error message. By clicking the "Submit" button, you certify that all the information on this application is true and complete to the best of your knowledge, and that you agree to our RETURN POLICY.--

To report problems about the web page or application only, please e-mail the webmaster. Please be aware, I have no information about the animals. Thanks!