Dog Adoption Application

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About You

Your Name (required)

Your Email (required)

What dog you want to adopt (required)

Primary Phone (required)

Secondary Phone

Address 1 (required)

Address 2

City (required)

State (required)

Zip Code (required)

County

About your home

Type of home you live in (required)
ApartmentDuplexHouseMobile Home

Do you rent or own?
RentOwn

Landlord's Name

Landlord's phone number

How long have you lived at this address?

Do you anticipate moving?
YesNo

Your ability to care for a pet

Have you adopted from us in the past?
YesNo

If yes when?

Is the dog going to be living with you?
YesNo

If no where will the dog live?

Are you prepared to meet the financial responsibility of owning a pet? (A cost of $300 to $500 per pet, per year)
YesNo

Have you had other pets in the last 5 years?
YesNo

If yes, where are they now?

Do you have any pets at your residence? (If yes, please list their breed, sex, age, and if they have been spayed or neutered.)

How many people live in your household?

Do the adults in the household know you plan to adopt?
YesNo

Do you have children?
YesNo

If yes, what are their ages?

Who is your veterinarian?

Veterinarian's phone number:

Why do you want a dog?

Do any of your family members have allergies to any animal?
YesNo

What size dog do you prefer?
SmallMediumLargeExtra Large

Breed?

Hair / Coat?

Please tell us the characteristics you would like in a dog?

Of these characteristics which are critical to you

What type of lifestyle do you have?

How many hours a day will the dog be WITHOUT adult care?

Do you have a fenced yard?
YesNo

If yes, fence height?

If no please tell us how you intend to exercise and potty the dog?

Where will the pet sleep?

How much time will the dog spend:

Indoors?

Outdoors?

If the dog will be outdoors, is there shelter or a doghouse available?
YesNo

Thank you for taking the time to answer our questions. We hope that by going through this process, we will reduce the chance of an inappropriate match both for you and for our animals. If you have any comments regarding this adoption application or our adoption process, please feel free to let us know as we are always looking for ways to improve! Again, thank you for considering a rescue pet and saving a life.

How did you hear about us?

How did you hear about this animal?

By submitting this application I understand that I may not surgically alter any dog I adopt from Home at Last, at any time, unless medically necessary. Doing so will result in the breaking of the adoption contract, and Home at Last may take any appropriate action for the welfare of the animal as noted in the adoption contract. I understand that this potentially debilitating procedure may lead to behavior problems.

I am aware that Home at Last has examined this dog, provided preventive medical care, and disclosed in writing all known medical issues. I understand that all animals can carry and transmit disease, some of which may affect other animals and/or people and that these diseases may be undetectable in what appears to be a healthy cat at the time of adoption. I understand that my new dog may have been exposed to contagious diseases such as ringworm and bordetella, and upper respiratory infection, and that these conditions are usually highly treatable. I accept this dog as AS IS at the time of adoption, taking responsibility for the dog’s care and well-being, including all medical care which may be necessary after the time the dog is released into my care. I understand that Home at Last is not responsible for any medical conditions not detected prior to the time of this adoption. I understand that I should keep my new dog isolated from other pets for a minimum of seven (10) days

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