I am interested in *
Adopting
Fostering
date *
Name of dog you are interested in *
Buddy (Dog - D2020011)
Eleanor (Dog - D2020012)
First Name *
Last Name *
Age *
Phone Number *
Email Address *
Address *
City *
State *
Zipcode *
Please LIST name, age and relationship of each person living in your home, including yourself *
Is everyone in your household in agreement to adopt a pet? *
No Yes
Employer(s) of you and your significant other *
Do you
Rent
Own
If you rent please list the name and phone number of your landlord
How long have you lived at this address *
Are you planning to move? If yes please explain:
Do you have a fenced in yard? *
No Yes
If you have a fenced yard what type of fence do you have?
Chain Link
Wood
PVC
Other
How tall is your fence?
none
3 ft
4 ft
5 ft
6 ft
Your new dog will spend most of his/her time: *
Inside
Outside
Do you smoke? *
No Yes
If YES, do you smoke inside your home?
Yes, but I do not smoke inside
Yes I do smoke in my home
No I do not smoke
When was the last time you owned a dog? *
Have you owned a dog before? *
If YES, Waht kind of dogs have you had in the past?
What happened to the pets you no longer have?
Do you currently have any pets in your home? *
No Yes
If YES, please include ALL of the following: Name, Breed, Age, Gender
Are you current pets spayed or neutered? *
No Yes
Are your pets current on vaccinations? *
No Yes
Do you plan on keeping your new pet current on vaccines, and heatworm flea and tick prevention? *
No Yes
What Veterinary facility are/will you be using? *
Vet's Phone Number *
Have you ever surrendered a pet to a shelter or rescue?
No Yes
If Yes, Please expain
Why are you looking for a dog at this time?
Is anyone in your home allergic to dogs?
No Yes
What characteristics are most attractive to you as an adopter?
Kid Friendly
Cat Friendly
dog Friendly
Mostly Quite
Non-shedding
House Trained
Crate Trained
Cuddler
Walks without pulling on the leash
Independent dog
Active
Laid Back
Shows affection to strangers
What behaviors would you deem unacceptable?
How do you plan on exercising your dog?
How many hours will your new dog be alone on an average day?
Less than 4 hours
4-8 hours
8-10 hours
10 hours or more
Where will the dog sleep at night?
When you are not home, where will your dog be?
In a crate
In the garage
In the yard
Loose in the house
Confined to one room in the house
Inside a kennel
Other
If you go away for a few days, or go on vacation, who will take care of the dog(s)?
How much are you willing to spend on medical bills for your dog?
Are you interested in adopting a dog with "special needs" (medical or behavioral)?
YEs
No
Maybe
Are you looking for a dog to hunt or herd with you?
No Yes
Are you looking for a guard dog?
No Yes
Would you be comfortable doing some training with your dog to improve manners such as jumping,pulling on the leash, counter surfing, puppy nipping or socialization?
Yes
No
Maybe
If YES, is there something specific you have in mind?
If a behavioral problem arises what would be your solution?
Contact a trainer to help
Return the dog to Open Arms
Work on it myself
Are you planning on taking your puppy/dog to training classes?
No Yes
Have you applied to adopt an animal from any other shelters or rescues?
No Yes
If YES, when and what was the result?
Are you willing and able to care for this pet for the rest of it's natural life?
No Yes
What provisions will you make for the dog should you become unable to care for it?
Are you willing to let an Open Arms Rescue representative visit your home to see where the pet will be living?
No Yes
Reference #1 *
Reference 1 phone number *
Reference #2 *
Reference 2 phone number *
Reference #3 *
Reference 3 phone number *
Is there anything else you would like us to know?