Name
*
First Name
Last Name
Phone
*
(###)
###
####
Email
*
How long have you lived at your current address:
*
Address
*
Which dog, or what type of dog, would you like to adopt?
*
Is your residence a:
*
house
apartment
condo
townhome
mobile home
other
How long do you plan on staying at this address:
*
Do you own or rent? If you rent, does your lease allow pets?
*
Landlord's name and phone number:
*
Occupation:
*
Your employer:
*
Please list all animals living in your home- pets name, dog/cat , breed and age
*
Please provide below the names and phone numbers of 2 personal references that you have known for more than 1 year:
*
I have a:
Fenced in yard
Dog run
Stationary tie out
Invisible fence/underground
other
Where will the dog spend the day when alone?
*
loose indoors
confined to room indoors
crated indoors
garage
basement
fenced yard
outside run
loose outdoors
Where will the dog spend its time when you are home?
*
loose indoors
confined to room indoors
crated indoors
garage
basement
fenced yard
outside run
loose outdoors
Where will the dog sleep at night?
*
loose indoors
confined to room indoors
crated indoors
garage
basement
fenced yard
outside run
loose outdoors
other
From which rooms and areas of the house will the dog be restricted?
*
How many adults are in the home? Ages?
*
How many children are in the home? Ages?
*
Does anyone in the home have allergies to animals?
*
What is the noise/activity level in your household?
quiet
moderate
active
very active
Who will be responsible for the care and training of the dog?
*
What is your experience with dogs?
*
first time
had dogs growing up
experienced
If you have children please describe their experience with dogs:
*
Do children visit your home often?
yes
no
How long are you willing to give the dog time to adjust to you, your family and environment?
*
All dogs need some level of obedience training/learning. Are you willing to seek some type of training for this dog if needed?
*
Have you ever surrendered an animal to a rescue group, pound or animal shelter? If so why?
*
Are you familiar with crate training, used for housebreaking and training? If so do you intend to use that method?
*
What veterinarian will you use for this pet?
*
Will you be willing to have a in home visit by one of our representatives?
*
yes
no
How long have you been looking for a pet?
*
Disclosures: No representations. You understand that this canine was previously unwanted, abandoned or lost and may have been rescued by Underdogs rescue from a dangerous, unhealthy and/or cruel situation. This could have long lasting effects on this canine. You agree that Underdogs rescue are making no representations or warranties about the condition, personality or temperament of this canine. No Liability. Underdogs rescue are not liable for any claims, legal actions, looses, injuries, damages, costs, expenses or liabilities whatsoever on connection with your adoption or ownership of this canine. Upon your signature below you are agreeing to taking this canine of your own free will and in agreement that Underdogs rescue will not be held for anything related to or with this canine.
*
Submitted date
*
MM
DD
YYYY
Adopter Printed name:
*