SOMERSET COTTAGE POODLE RESCUE

ADOPTION APPLICATION

PLEASE COMPLETE BY TYPING IN THE BLANKS OR USING BOLD FOR THE MULTIPLE CHOICE QUESTIONS.

Adopter(s) Name (First, MI, Last): ______DOB:______

Address:______

City:______County:______Starte:______Zip:______

Place of Employment :______Since (Mo/Yr)______

E-Mail: ______Home Phone: ______

Work Phone: ______Mobile Phone: ______

Co-Adopter (First, MI, Last): ______DOB:______

Place of Employment: ______Since (mo/Yr): ______

E-Mail: ______Home Phone: ______

Work Phone: ______Mobile Phone: ______

Name of Dog applying for : ______

  1. Why do you want to adopt a dog?
  2. What do you think are the most important responsibilities in owning a dog?
  3. Please list any preferences (age, sex, breed, personality):
  4. Have you submitted an application with another organization for a dog at this time: YES____NO___
  5. Have you ever had an application declined for adoption of an animal from a welfare group/animal control facility ? YES ______NO______Explain :______
  6. Are you willing to take the time to housebreak a dog, and do you understand that changing a dog’s environment may cause the dog to have accidents ? YES______NO______
  7. If a behavioral problem arises, what steps will you take to work on it ?
  8. If you are applying for a puppy/dog who is not housetrained, how will you housetrain the dog ?
  9. Does any member of the family have any allergies to animals ? YES______NO_____ Explain:______
  10. Describe the kinds of personal situations where you might have to return your adopted dog, i.e. job loss, children, move, marital change, etc.
  11. For whom are you adopting the dog? SELF______GIFT______OTHER FAMILY MEMBER_____

Page 2

  1. How many people live in your home?
  2. Are there any children in the household? YES______NO______If yes, what are their ages? NOTE: Rescue often does not place dogs in homes with children under the age of 8 yrs.
  3. Who will be responsible for feeding and taking the dog outside?
  4. Who will take care of the dog in the absence of the primary caretaker?
  5. What reading/or other steps have you taken to prepare for a new dog?
  6. Will you take obedience training?
  7. Will you be willing to obtain an appropriately sized, open wire crate, if recommended ? YES____NO_____
  8. What kinds of animals have you owned?
  9. Describe those pets you CURRENTLY own or dogs you have owned in the past 10 years: IF YOU HAVE MORE ANIMALS THAN SPACE PROVIDED, COPY AND PASTE THEFOLLOWING SECTION AS MANY TIMES AS NEEDED.
  1. Name______Type______Age ___

Sex ____Cause of Death ______

Is the pet Spayed or Neutered ? YES______NO ______

What brand of Heartworm preventative and Flea/Parasite control do you use ?

What brand of food do you feed on what kind of schedule ?

Do you free feed ?

Primarily Indoor or Outdoor ? Explain: ______

When and where did you get the animal ?

Comments:

  1. Describe all pets you previously owned in the past 10 years using the following form:
  1. Name: ______Type______

Age______Sex______

Was the pet spayed or neutered ? YES_____ NO ____

Primarily Indoor or Outdoor ? Explain:

When and where did you get the animal:

Year deceased ( or last year you had pet) ?

Cause of death, or where the pet is now (detail):

PAGE 3

  1. List each vet/animal hospital where your animal (s) received care over the last 10 years:

If several vets were used, please explain and provide approximate service dates. Please note that application review cannot be completed unless each vet’s phone number is provided. If the space provided is insufficient, copy and paste the following section as many times as needed.

Name and phone no with area code (for each): ______

What owner name(s) are records listed under ? ______

Date of last vet visit :______

  1. Name of vet you will use for your new pet ?
  2. What kind of veterinary care do you plan to provide?
  3. Will you put your new pet on a Health care vet plan ?
  4. Have you considered the extra expense that will come with having a dog including vet care, food, supplies, equipment, grooming, toys, training and boarding ? Please explain:
  5. Do you own or rent your residence ? OWN ______RENT ______
  6. If you rent. Landlord Name ______Landlord phone# ______
  7. What type/size of pets are allowed ?

If you have rented your current residence for under a year, please provide prior address and prior landlord contact phone number:

Prior Landlord’s name: ______Landlord Phone# ______

  1. Do you have a fenced yard ? YES______NO______

NOTE: SECURE, FULLY FENCED YARDS ARE TYP9ICALLY REQUIRED FOR HOMES WIITH CHILDREN UNDER AGE 12 YRS. FOR SOME DOGS, FENCES OF MINIMUM 5 TO 6 FT ARE REQUIRED.

What type of fence ?

How Tall ? (Give range of heights if relevant)

Does the fence belong to you or neighbors?

Any holes or gaps ? YES ______NO______

Is the fence attached to the home ? YES ______NO ______

  1. If you do not have a fence do you plan to install one ? YES______NO______If yes, when?
  2. Describe the circumstances in which you would walk /exercise a dog on leash ?
  3. Describe the circumstances in which you would walk/exercise a dog off leash?
  4. How often will you exercise the dog and for approximately how long?
  5. How many hours will the dog be left unattended (i.e. work day) ?
  6. Where will the dog sleep?
  7. When you are not at home, where will the dog be kept ?
  8. When no one is at home (i.e at work, shopping) where will the dog stay? Be specific .
  9. Have you used or do you plan to install a dog door ?

PAGE 4

  1. How often do you travel ?
  2. What will you do with the dog when you travel ?
  3. If you move, what will you do with the dog ?
  4. Are you or your spouse with the Military? YES______NO ______
  5. Are you aware that Rescue requires all dogs/cats in a home be spayed/neutered ?

YES _____NO_____

  1. Have ALL ADULT family members agreed upon a dog?
  2. List 3 NON-RELATIVES for references, along with their email addresses and phone numbers.
  1. ______
  2. ______
  3. ______

Our adoption fee /donation varies for each dog and we usually include it in the dog’s description. We try to recover the money we spend on the dog for veterinary exams, immunizations, spaying/neutering, heartworm tests, flea/tick control, food, grooming etc. Most of the time we have to pay shelter fees for the dog we rescue and sometimes we incur expenses in having the dog transported to his/her foster home.

Some dogs come to us with medical problems which need to be addressed before they can be adopted. We are not in this for the money and we will always ask a fair price for each of our dogs. If adoptees require a dog to be professionally groomed before transfer to them this cost will be in addition to the adoption/donation fee and typically runs around $50 - $60. Per dog.

I HAVE READ THE ABOVE INFORMATION CAREFULLY AND HAVE FILLED OUT THIS APPLICATION HONESTLY. I UNDERSTAND THAT THE OMISSION OF INFORMATION AND/OR FAILURE TO ANSWER ALL QUESTIONS AND SIGN THE APPLICATION CAN RESULT IN THIS APPLICATION BEING DECLINED. I GIVE SOMERSET COTTAGE POODLE RESCUE PERMISSION TO FULLY INVESTIGATE THE INFORMATION PPROVIDED AS WELL AS CONTACT VETERINARIANS AND RELATED OFFICIALS. IF THE APPLICATION PASSES THIS REVIEW, I AGREE TO A HOME AND YARD VISIT ON A MUTUALLY AGREED DATE BY A VOLUNTEER BEFORE AND ADOPTION DECISION IS MADE.

SIGNATURE ______DATE______

Please return by email to Lesley Clark at .