Clone of New Client Form

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Adoption Application

Please review our How to Adopt page before filling out an application.

Adoptable Dogs

Thank you so much for taking the time to fill out this application. Some SCCR dogs may be best suited for a specific housing situation, so please answer the following questions as honestly as possible. We respect and value diverse backgrounds and are committed to creating an environment that is inclusive and nurturing for all.
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Name* This field is required.
First Name
Last Name
3
Date of Birth* This field is required.
Month
Day
Year
4
Email* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
6
Address* This field is required.
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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We keep the vast majority of our adoptions within a 90 minute driving radius of our adoption center in Palatine. If you are outside this area, please email us at adoptions@sccrescue.org before completing an application.
9
Your Occupation and Employer:
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Are you applying to adopt a specific dog?* This field is required.
Please Select
Please Select
Yes
No
11
Dog Name
12
Some of our pups have special needs so it is important for SCCR to know who will be living with the new dog. Please let us know how many people will be living in the new dog’s household.
Please Select
Please Select
1
2
3
4
5
6
7
8+
13
It is important for SCCR to know who will be living with the new dog. Please let us know how many individuals will be living in the new dog’s household.
Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
14
Add Another Person?
Yes
No
15
Person #2
Person 2 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
16
Add Another Person?
Yes
No
17
Person #3
Person 3 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
18
Add Another Person?
Yes
No
19
Person #4
Person 4 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
20
Add Another Person?
Yes
No
21
Person #5
Person 5 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
22
Add Another Person?
Yes
No
23
Person #6
Person 6 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
24
Add Another Person?
Yes
No
25
Person #7
Person 7 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
26
Add Another Person?
Yes
No
27
Person #8
Person 8 Name
Age
Gender Identity
Please Select
Please Select
Yes
No
History of Dog Allergies?
Please Select
Please Select
Yes
No
Aware of Possible Adoption?
28
How many other pets have you had within the last 10 years (including current pets)?
Please Select
Please Select
0
1
2
3
4
5
6
7
8+
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Please tell us about any current pets first and then other pets you have had in the last 10 years.Pet #1
Pet Name #1
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
30
Pet #2
Pet Name #2
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
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Pet #3
Pet Name #3
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
32
Pet #4
Pet Name #4
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
33
Pet #5
Pet Name #5
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
34
Pet #6
Pet Name #6
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
35
Pet #7
Pet Name #7
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
36
Pet #8
Pet Name #8
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
37
Pet #9
Pet Name #9
Type/Breed
Age
Please Select
Please Select
Female
Male
Sex
Please Select
Please Select
Yes
No
Spayed/Neutered?
Please Select
Please Select
Yes
No
Still Own?
38
Housing Information
39
Housing Type
Single family home
Multi-family Home (townhome, condo, apartment, etc.)
Other
40
Do you have a Landlord?* This field is required.
Yes
No
41
Landlord's Name and Phone Number or Email Address
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Does your landlord, property manager or HOA have breed, # of pets or weight restrictions? If so, what are they? (Please plan to bring a copy of your lease, HOA regulations or a letter confirming acceptable pets when coming to meet a dog.)
43
Do you have a fence or designated outdoor area and is it enclosed?* This field is required.
Yes
No
44
If applicable, enter your fence type and height
45
Are you willing to work with a dog who needs additional support (training or medical)?Please be aware that at the time of adoption SCCR will no longer be responsible financially.
Please Select
Please Select
Yes
No
46
What is your household's typical daily schedule?* This field is required.
47
Why are you considering adopting a dog?* This field is required.
48
Where will you keep the dog when you are at home?* This field is required.
49
Where will you keep the dog when you are not at home?* This field is required.
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Where will the dog sleep at night?* This field is required.
51
How will you discipline the dog?* This field is required.
52
What behaviors are you and your family unwilling to tolerate regarding dog behavior?* This field is required.
53
What behaviors are you and your family unwilling to tolerate regarding dog behavior?* This field is required.
54
SCCR requests that each adopted dog go through basic obedience training (using positive reinforcement methods). Are you willing and able to cover that cost at your own expense?* This field is required.
Please Select
Please Select
Yes
No
55
If a medical emergency arises, are you willing and able to cover that cost at your own expense?* This field is required.Please be aware that at the time of adoption SCCR will no longer be responsible financially.
Please Select
Please Select
Yes
No
56
If you and your family move in the future, what will your plan be to ensure adequate care for your dog?* This field is required.
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If you experience a major life change (medical emergency, change in marital status, birth of a child, etc.), what will your plan be to ensure adequate care for your dog?* This field is required.
58
Have you ever surrendered an animal to a rescue or shelter, or lost a pet due to something other than natural causes?* This field is required.
Please Select
Please Select
Yes
No
59
I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that Second City Canine Rescue reserves the right to deny my request to adopt an animal for any reason. I, along with those persons who may accompany me, assume risk of injury which may be incurred as a result of my viewing any animal under the care of Second City Canine Rescue.* This field is required.
Yes
60
Please sign me up for Second City Canine Rescue's mailing list.
Yes
61
Please verify that you are human* This field is required.
Should be Empty:

Adoption Application

Housing Information