First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Which animal are you interested in*
Choose an animal: **No specific dog or Dog not listed** Ash TX ATDR Bessie ATDR Blue ATDR Norman ATDR Ollie Bae Bae NJ aka Benji Chente NJ Cousin Brucie TX Dawkins TX Hermey TX Jessie's Girl TX Kari's Tippy TX Katie Girl WV Marlin TX Maser TX Midge TX Ms. Lady the Great Pyrenees in Texas NAC Suey Nacho NJ Ohana TX Oolie fka Chella's Tummi's Oolong Pinto TX Polska TX Pony Boy TX Ronan TX Scrappie & Sofie NJ - Bonded Pair Seren TX Seren's David TX Seren's Jeff TX Seren's Juli TX Seren's Tray TX Shannon's Charlie Brown TX Souffle TX Stewie TX XP Cammie in Texas XP Cutie (Q) - Texas XP Jaskier - Wayne, NJ

Enter name(s) of other dogs you are interested in

I/we understand that NorthStar Pet Rescue will make every effort towards the adoption of the dog you are requesting, pending your application approval, but I/we DO UNDERSTAND that this application does not guarantee the adoption of the dog you are applying for.*
Choose one: Yes, I/we do understand that I am not guaranteed the dog I have applied for No

I/we understand that NorthStar makes no guarantees or statements regarding any dog's age, breed, health, or temperament. While NorthStar has made every effort to provide accurate history and assessment of all the dogs, NorthStar is not able to guarantee any dog's age, breed, medical status or history, behavior or disposition*
Choose one: Yes, I/we understand No

I/we understand that NorthsStar may require a home check before the adoption is finalized and that NorthStart has the right to make periodic visits to the adopter's premises for the purpose of checking on the health and general welfare of the animal.*
Choose one: Yes, I/we understand No

I/we understand that ALL HOULSEHOLD MEMBERS must be present at the meet & greet with the dog I am trying to adopt*
Choose one: Yes, I/we agree that all household members will be present at the meet & greet No

I/we understand that all dogs currently part of the household, as well as those that visit frequently, must be present at the meet & greet with the dog I am trying to adopt*
Choose one: Yes, I understand that all dogs currently part of the household or that visit frequently will be present at the meet & greet No

I/we understand that if for any reason I can no longer take care of the dog, he/she MUST be returned to NorthStar Pet Rescue*
Choose one: Yes, I/we understand No

I/we understand that if for any reason NorthStar deems that the dog I adopted is not being cared for properly (e.g. repeatedly runs away, kept outside, etc.) that I will be required to return the dog to NorthStar*
Choose one: Yes, I/we understand No

Enter additional information you would like to provide or comments for any question you disagree with

I/we hereby release NorthStar Pet Rescue and its volunteers, directors, members, and representatives of any and all possible claims arising from injury or damage caused by any NorthStar dog to any person or property, including any expenses related thereto.*
Choose one: Yes, I/we understand No

Do you Own, Rent, or Other? (If another individual actually owns the home, e.g. parent, partner then select "other")*
Choose one: Own Rent Other

In what type of home do you live?*
Choose one: Single family home Apartment Duplex Condominium Townhouse Mobile home Military housing Other - describe below

If Other, describe:

Please enter Unit or Apartment Number, if applicable:

How long have you lived at this address?*
Choose one: Less than one year 1 to 3 years Greater than 3 years

Is your name on the lease or mortgage/title?*

Is your yard fenced?*
Choose one: No fence Partially fenced Completely fenced, at least one side less than 4 ft high Completely fenced, all sides at least 4 ft high or higher Invisible (electric) fence for dog Other, describe below No yard

If other, describe:

If your yard is fenced, please describe the materials the fencing is made from

Are ALL members of your household in agreement about adopting a dog?*
Choose one: No I haven't told them yet Yes

Indicate your age:*

List ALL members of your household, INCLUDING yourself: First & Last Name, Relationship, and Age*

Does anyone in the household have PET allergies? If yes or unsure, please explain. If no, enter "NA"*

Enter: Name of complex or name of agency AND phone number. If no complex/agency enter name of Landlord and phone number*

Does your landlord have pet restrictions such as number of pets, type of pets, breed, size, etc.? If yes, describe. If no, enter "NONE"

Provide name of Owner's Association or Co-op Board AND phone number. If you do not have a home owner's association or Co-op Board enter "NA"*

Dos your association or coop have pet restrictions such as number of pets, type of pets, breed, size, etc.? If yes, describe. If no, enter "NONE"

List CURRENT PETS: 1) Name of pet; 2) Type; 3) Breed; 4) Current age; 5) How long have you had pet; 6) spayed/neutered?; 7) Up to date on vaccinations? If you currently do not have a pet, please enter "NONE"*

List animal hospital/clinic where your CURRENT animals receive / received care. Provide name of hospital, phone number, and last name (if different from applicant's last name) associated with pet. PHONE VET AND LET THEM KNOW WE WILL BE CALLING

List all PETS that you have had in the last 10 years, but are no longer with you. Provide: 1) Name of pet; 2) Type; 3) Breed; 4) Age when pet passed/re-homed; 5) How long did you have pet? 6) Year pet passed/re-homed? If you haven't any PAST pets, please enter "NONE"*

List animal hospital.clinic where your PAST animals received care. Provide name of hospital, phone number, and last name associated with pet (if different from applicant's last name). PHONE VET AND LET THEM KNOW WE WILL BE CALLING

Have you ever re-homed a pet or returned one to a shelter/rescue? If yes, please provide detailed circumstances including name of pet, type of pet, reason for re-homing/return, and how long did you have the pet. If you have never re-homed/returned a cat/dog, enter "NA"*

Most of NorthStar's dogs are mixed breeds and the breeds listed are often guesses based on appearance of the dog. Please describe breed PREFERENCES or AVERSIONS. If you have NO preferences or aversions please enter "ANY BREED"*

What age dog are you looking for? Check all that apply.

Size preference for dog when full grown. Check all that apply. NOTE: we will not know how big a puppy will get as we do not know the breeds that may be mixed in the DNA.

Are you looking for a dog of a specific sex?*

What energy level would work with your life style? Check all that apply.

What activity level best describes your home?*
Choose one: QUIET (minimal visitors / activities) MODERATE (some visitors / activities) VERY ACTIVE (many visitors / activities)

What kind of outdoor activities will you share with your dog (choose all that apply)?

Describe your ideal dog

Why do you want to adopt a dog at this time? Check all that apply

How soon do you want to adopt?*
Choose one: I am thinking probably within the next week I am taking my time, a few weeks are fine I am browsing, it could be a few months I am uncertain, it would depend on me finding the right dog

Who will be the primary caretaker for the dog?*

Please describe, in detail, how long the dog will be alone each day. Include commuting times to and from work. At what time does the last person leave the home in the morning? What time does the first person return home in the evenings? *

Where will the dog be kept while alone?*

What arrangements will you make if you go away for vacation or business?*

Do you have a plan for the long term care of your dog should you no longer be able to care for it, e.g. illness, relocation, change in life style? If so, please explain. If not, enter "none."*

Are you aware that you are making a commitment that may last 12-17 years, to take responsibility for the dog, provide medical care, proper nutrition, and a loving home?*

The average yearly cost for a HEALTHY dog is approximately $500 - $700 a year. Are you prepared to bear this cost?*

Describe the kind(s) of PERSONAL situations where you would consider surrendering your dog. Check all that apply

Are there situations specific to the dog where you would consider surrendering your dog? Check all that apply

How long do you think it should take a dog to adjust to his/her new home and what are your expectations during this period?*

How do you plan on exercising your dog? How frequently?*

Are you willing to house train a dog?*

Name of company, town & state in which you work*

How long with the company*

On average how many hours a day are you away from the home>*

Reference #1: First & Last Name*

REF #1: Town & State*

REF#1: Phone number (please enter with dashes, e.g. 123-555-1234)*

REF#1: Relationship, check all that apply

REFERENCE #2: Name*

REF#2: Town, state*

REF#2: Phone number (please enter with dashes, e.g. 123-555-1234)*

REF#2: Relationship, check all that apply

Reference #3: First & Last Name*

REF#3: Town, state*

REF#3: Phone number (please enter with dashes, e.g. 123-555-1234)*

REF#3: Relationship, check all that apply

I/we attest that the information provided on this application is true and accurate to the best of my /our knowledge. I/we attest that that we understand that the completion and submission of this application does not guarantee adoption of a NorthStar dog.*
Choose one: Yes, I/we agree and understand No

In filling out the application electronically, entering your LEGAL name below substitutes for a signature. By entering your complete and legal name, you are agreeing to abide by the requirements set in the NorthStar Pet Rescue policy within this application*
Choose one: Yes, I/we understand and agree with the above statement No

Enter your complete and legal signature*

BEFORE clicking the "SUBMIT" button please review the application and ensure it is complete. Please provide necessary names and phone numbers for veterinarian, home owner, home owners association/management company, etc. Missing / incomplete information may result in having your application declined and ask you to resubmit the application with all the necessary information. NOTE: ALL questions with an asterisk "*" are required to be filled in.

After clicking the "SUBMIT" button please scroll to the TOP of the form/page to see whether your application was submitted successfully OR whether there are error(s) in your application that need to be corrected. NOTE: ALL questions with an asterisk "*" are required to be filled in.