Super Dog NY dog rescue - Adoption Application
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                         Super Dog NY Dog Rescue
                                  845-215-9001
                                  845-521-8494
                                               
                           Gis.goldsmith@gmail.com
                http://superdognydogrescue.vpweb.com
                                                  
                                                  Dog Adoption Application Form
                        Copy and paste into email , fill out , hit reply and send !

 

Contact Information
 
Full name:     ______________________________________________________________
 
Occupation:   ______________________________________________________________
Address:        ______________________________________________________________
 
How long at this address:   ­­­­­­­­­­­­­­­­­­­­­­­­­___________________________________________________
 
Daytime Phone:  ___________________________________________________________
 
Evening Phone:    __________________________________________________________
 
Best time to call:  ___________________________________________________________
 
Email address:      __________________________________________________________
 
 
Family & Housing
 
How many adults are there in your family (their relationship to you)?
_________________________________________________________________________
 
How many children (ages)?
_________________________________________________________________________
 
What type of home do you live in single family, town home, apartment, farm, etc.?
_________________________________________________________________________
 
Please describe your household:  __ Active    __ Noisy    __ Quiet   __ Average
 
If you rent, please give the rules governing pets and the landlord’s name and number:
 
(by providing this information you are allowing  to contact your landlord please inform them of this call so they will speak with us)
 
Does anyone in the family have a known allergy to dogs?     _________________________
 
Is everyone in agreement with the decision to adopt a dog?   _________________________
 
Do you have time to provide adequate love and attention?   _________________________
 
Other Pets
 
What other pets do you have (specify type and number)?   
 
 
Are these pets up to date on vaccines? _________________________________________
 
Are these pets spayed/neutered?  If not..why?____________________________________
 
_________________________________________________________________________
 
Have you every surrendered a pet? If so, why?
 
_________________________________________________________________________
 
Have you ever had a pet euthanized? If so, why?
 
_________________________________________________________________________
 
Have you ever lost a pet to an accident?
 
_________________________________________________________________________
 
How do you discipline your pets and why?
 
_________________________________________________________________________
 
 
Veterinarian
 
Do you have a regular veterinarian?     __ Yes    __ No
 
Veterinarian’s name:  _______________________________________________________
 
Clinic Name:              _______________________________________________________
 
Clinic Address:          ________________________________________________________
 
Clinic Phone: About the Dog You Wish to Adopt
 
What is your idea of an ideal dog and why?
 
Desired age:  __________            Desired Size: _____________________________________
 
Desired breed: _______________________________________________________________
 
Breed you would not adopt:_____________________________________________________
 
Desired sex: _ Spayed Female _ Neutered Male _ No preference
 
Willing to adopt:           __ outgoing/hyper dog                          __ shy dog
__ dog that needs regular medication     __ dog that needs training  
__ dog that needs grooming                  __ None of these
 
 
 
 
Where will the dog spend the day? (describe)
_________________________________________________________________________
 
Where will the dog spend the night? (describe)
_________________________________________________________________________
 
Number of hours (average) dog will spend alone?  _________________________________
 
Who will have primary responsibility for this dog's daily care?  _______________________
 
Who will have financial responsibility for this dog?  ________________________________
 
Do you agree to provide regular health care by a Licensed Veterinarian?    __ Yes   __ No
 
Do you agree to keep the dog as an indoor dog?   __Yes    __No
 
When the dog goes out, how do you plan to supervise it? Fenced yard?
 
Do you agree to contact  Super Dog if you can no longer keep this dog?   __Yes    __No
 
Are you be willing to let a representative of  Super Dog visit your home by appointment?
__Yes    __No
 
How did you hear aboutus  _____________________________________________________
 
Would you be interested in fostering?   __Yes     __No    __Would like to know more
 
 
 
 
 
 
 
Personal References
Please list someone who is familiar with both you and your pets.
 
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
 
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
 
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
 
___________________________                                                                               _________
(Signature)                                                                                                                      (Date)
 
 
 
 
 
 
 
 
 
 
 






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