Papillon 911 Rescue and Adoption, Inc

Adoption Application

This may seem like an excessively detailed, even invasive, questionnaire but please keep in mind that the more information we have about you, your household and your expectations of your rescued dog, the easier it will be to make a successful match. Finding the perfect match between adopter and dog is our most important goal.Please read the Adoption Guidelines before completing this application.Be aware that you must travel to the Foster Home to meet the dog and his Foster Family. We do not ship or deliver our precious Papillons.

NOTE: To fill out this form, just click on the light blue areas and begin typing your answer. Where it says “Select one” just click it and select your answer. You can use the tab key on your keyboard to move to the next field to be filled out.
*Instructions for sending your completed form are at the bottom of this document.*
Where did you hear about PAP 911 Rescue?
Member? Who?
Friend? Who?
Website?
Petfinder.com / Select oneYesNo
Which Papillon are you interested in adopting?
Is this the only Papillon you would be interested in? / Select oneYesNo
Contact Information
Today’s Date:
Name:
Address:
City, ST, ZIP
Birthday:
Phone Number
Home:
Work:
Cell:
Email Address:
How many adults in the household?
Please list their names, agesand
occupationsincluding you:
How many children
in the household?
Please list their names and ages:
If no children in the home, do grandchildren, nieces/nephews
or other kids ever visit? / Select oneYesNo
Who will be the primary
caregiver for the new dog?
Does this person work
away from the home? / Select oneYesNo
How many hours per day will the
dog be left alone? Please explain.
How long at current address?
Is it a house, condo, apartment or other? / Select oneHouseCondoApartmentOther
If other please specify
Do you own or rent? / Select oneOwnRent
If condo or apartment, what are the rules of pet ownership? (answer on next line)
If you rent, please provide the name and phone number of the property owner:
If you live in a condo, please provide the name and number of a condo representative:
Do you have a securely fenced yard? / Select oneYesNo
If so, what type of fence is it
(wood, chain link, block wall, etc.)? / Select oneWoodChain LinkBlock WallOther
If your fence is not a solid privacy
fence, how much space is between
pickets or boards?
How high is it?
Is there a doggie door leading to the yard? / Select oneYesNo
If you do not have a fenced yard,
where and how often do you plan
to take your dog to potty?
Will the dog be on a leash?
Under what circumstances would you allow your dog to be off-leash?
Are there any areas of the house
where the dog will not be allowed? / Select oneYesNo
If so, how will you keep the dog out of them?
Will the dog be allowed on the furniture? / Select oneYesNo
If not, how will you keep it off the furniture?
Will the dog be given the run of the
house when no one is at home? / Select oneYesNo
Please explain previous question
Where will the dog sleep?
Will you use a crate for your new dog? / Select oneYesNo
Have you ever trained a dog to respond to simple commands? / Select oneYesNo
If so, how would you describe the method you used?
How will you discipline your new dog for undesirable behavior?
If your new dog is not housetrained, how will you housetrain it?
Are you aware that even housetrained dogs need a period
of adjustment in a new home? / Select oneYesNo
What will you do if the dog has “accidents” in the house?
How many dogs have you owned?
How long did you have your last dog?
Did you have the dog until it died? / Select oneYesNo
If so, at what age did it die?
How did this dog die?
If not, what happened to it?
Was it spayed/neutered? / Select oneSpayedNeutered
Can you tell us about some of your previous pets and what happened to them?
Do you currently have a dog(s)? / Select oneYesNo
If so, please list their breed, age, sex, weightand whether they are spayed/neutered:
Where have your previous or current dogs mostly lived, indoors or outdoors? / Select oneIndoorsOutdoors
Do you have any other pets or farm animals? If so, please list species:
If you have a cat(s), describe how you hope your new dog will interact with it:
How do you intend to exercise your new dog?
Do you have what you consider an active
lifestyle or are you more the couch potato type? / Select oneActive LifestyleCouch Potatoe
Do you travel a lot? / Select oneYesNo
When you go out of town, what arrangements will you make for the
care of your rescued dog?
Why do you want a dog (or another dog) at this time?
Why do you want a Papillon in particular?
Have you ever had a Papillon before? / Select oneYesNo
Have you ever had a rescued dog before? / Select oneYesNo
Why do you want a rescued dog?
What characteristics do you especially want in your new dog?
What characteristics do you not want in your new dog?
What will you do if your new dog has some unwanted characteristics?
What is the age range of the dog you hope to adopt?
What sex and why?
How important to you is it that the dog already be housetrained? / Select oneNot ImportantImportantVery Important
Are you willing to adopt a special needs dog
(requires medication, deaf or blind, etc.)? / Select oneYesNo
Are you aware that Papillons can be big barkers? / Select oneYesNo
What will you do if your rescued dog barks a lot?
Please provide the name and phone number of your current or previous veterinarian:
Please provide the names and phone numbers of three personal references, not including family members. (Please note that it may not be necessary to contact all three.):
Do you agree to have a representative of Papillon 911 Rescue visit your home prior to adoption? / Select oneYesNo
Do you agree to a follow-up visit after adoption? / Select oneYesNo
Do you agree to pay an adoption donation of $100-$450, depending on the dog’s age, health and possible special needs? / Select oneYesNo
If anything were to happen to you that prohibits you from keeping the dog, do you understand that a Papillon 911 Rescue must be notified and the dog must be returned to us? / Select oneYesNo

Thank you for completing this application and thank you for wanting to give a forever home to one of our rescued Papillons!

Applicant Signature / Enter Date
Your typed name is as binding as your signature.

Please fill out in full.

PAPILLON 911 Rescue and Adoption, INC
Foster/Adoption applicant authorization and written release.
This form authorizes the Pap 911 organization to obtain information and also authorizes release of information from service providers and references to determine
if the applicant may adopt or foster for our organization.

I,
currently residing at / City
State / Zip

Hereby give permission to release information or records in order for me to foster/adoption of a dog from Pap 911.
All information requested will only pertain to fostering or the adoption of a dog. All information will be kept confidential used solely for adoption/fostering of a dog.
I understand that:
That Pap 911 is only seeking information for me to become approved to foster or adoption of a dog.
I may or may not be eligible for adoption/fostering under Pap 911's guidelines.
The permission that is hereby granted shall expire (1) one year from the date below.

Signed / Date
Your typed name is as binding as your signature.

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Papillon 911 Rescue and Adoption Adoption Application revised 9-13-09Page 1 of 7