Dog Adoption Application & Reference Verification Form

Dog Adoption Application & Reference Verification Form

Complete your application and provide exactly 3 adult references so the rescue can verify your home and readiness for a safe, permanent placement.
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I confirm that I am 18 years of age or older
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Length of Time at Current Address (Years)
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method
Best Time to Contact

Hour Minutes

AM/PM Option
Occupation / Employer
Work Schedule or Typical Hours Away From Home
Spouse / Partner Full Name and Phone Number (if applicable)

First NameMiddle NameLast Name
Housing Information
Do you own or rent your home?

Other
Type of home

Other
Landlord or Property Manager Name
Landlord or Property Manager Phone
Please enter a valid phone number.Format: (000) 000-0000.
Landlord or Property Manager Email
example@example.com
Do we have your permission to contact your landlord or property manager?
Do you have written permission to keep a dog where you live?
Are there any breed, weight, or size restrictions?
If yes, please explain the restrictions
Do you have a fenced yard?
If no fenced yard, describe your exercise and potty plan
Dog You Are Interested In
Dog’s Name
Why are you interested in this dog?
Qualities you are looking for in a dog

Other
Activity / energy level you are prepared for
Main reason for adopting this dog
Have you met this dog yet?
Willingness to complete a meet-and-greet with all household members and current dogs before adoption
Interested in the optional 10-day trial / pre-adoption period
Current & Previous Pets
Do you currently have any pets?
Current pets (complete one row per pet)
Have you owned dogs before?
Dogs and other pets owned in the last 10 years
Have you ever surrendered, rehomed, returned, or given away a pet?
If yes, please explain the circumstances.
Have you ever had a pet humanely euthanized for behavioral reasons?
If yes, please explain the circumstances.
Have any of your pets ever been lost, stolen, or killed in an accident?
If yes, please explain what happened to each pet.
Have you ever been denied an adoption by another rescue or shelter?
If yes, please explain the circumstances.
Have you ever been cited, investigated, or charged for animal cruelty, neglect, dangerous-dog violations, or similar animal-related offenses?
If yes, please explain the circumstances.
Veterinary Information
Veterinary clinic name
Veterinarian name (if known)
Clinic address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Clinic phone
Please enter a valid phone number.Format: (000) 000-0000.
Clinic email (if known)
example@example.com
Name(s) pets were listed under at this clinic
Authorization to contact veterinarian and verify care records

Current pets status

Rows	Yes	No	Not applicable	Explain
Current dogs/cats are up to date on core vaccinations
Current pets are on flea and tick prevention as appropriate
Current pets are on heartworm prevention as appropriate
All current pets are spayed/neutered

Care, Training & Financial Readiness
How many hours per day will the dog normally be left alone?
Who will be primarily responsible for the dog's care?

Other
How many walks or exercise sessions do you expect per day?
What exercise and enrichment will you provide?

Other
Are you willing to crate train if recommended?
Are you willing to attend professional training if needed?
What training methods have you used before?
How would you handle accidents in the home?
How would you respond to chewing or destructive behavior?
How would you respond to barking, separation anxiety, fear, reactivity, resource guarding, or aggression?
Under what circumstances would you consider rehoming or returning a dog?
Are you financially prepared for the dog's routine and unexpected care needs?

Other
What would you do if the dog needed an unexpected veterinary procedure costing $1,000–$3,000 or more?
Do you currently have pet insurance or plan to obtain it?
Who will care for the dog during vacations, deployments, hospitalization, or other emergencies?
Children & Other Animals
Are there children living in the household?
Ages of children in the household
Do children regularly visit the home? If yes, please list their ages and how often they visit.
Have the children lived with dogs before?
Are there other pets in the home?

Other
How will you introduce the new dog to any current pets?
If recommended, are you willing to keep pets separated and complete slow introductions?
Three Required Personal References / Points of Contact
Please provide exactly 3 adults who know you well and can speak honestly about your responsibility, home environment, treatment of animals, and ability to provide a stable permanent home. Ideally, your references should not all live in your household. References may be contacted by phone, text, or email.
Reference #1 — Full Name

First NameMiddle NameLast Name
Reference #1 — Relationship to Applicant / How They Know You
Reference #1 — How Long Have You Known This Person? (Years / Months)
Reference #1 — Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #1 — Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #1 — Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #1 — Email Address
example@example.com
Reference #1 — Preferred Contact Method
Reference #1 — Best Time to Contact

Hour Minutes

AM/PM Option
Reference #1 — Occupation / Employer (if known)
Reference #1 — Is This Person Aware They Are Being Listed?
Reference #2 — Full Name

First NameMiddle NameLast Name
Reference #2 — Relationship to Applicant / How They Know You
Reference #2 — How Long Have You Known This Person? (Years / Months)
Reference #2 — Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #2 — Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 — Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 — Email Address
example@example.com
Reference #2 — Preferred Contact Method
Reference #2 — Best Time to Contact

Hour Minutes

AM/PM Option
Reference #2 — Occupation / Employer (if known)
Reference #2 — Is This Person Aware They Are Being Listed?
Reference #3 — Full Name

First NameMiddle NameLast Name
Reference #3 — Relationship to Applicant / How They Know You
Reference #3 — How Long Have You Known This Person? (Years / Months)
Reference #3 — Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #3 — Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3 — Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3 — Email Address
example@example.com
Reference #3 — Preferred Contact Method
Reference #3 — Best Time to Contact

Hour Minutes

AM/PM Option
Reference #3 — Occupation / Employer (if known)
Reference #3 — Is This Person Aware They Are Being Listed?
Should be Empty:

Dog Adoption Application & Reference Verification Form

Applicant Information

Housing Information

Dog You Are Interested In

Current & Previous Pets

Veterinary Information

Care, Training & Financial Readiness

Children & Other Animals

Three Required Personal References / Points of Contact