Super Dog NY dog rescue - Adoption Application

                         Super Dog NY Dog Rescue
                                                  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?
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.
Relationship (relative, neighbor, friend, etc.):
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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