First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

How did you find out about Small Dog Rescue of New England?*

Have you adopted from Small Dog Rescue before?

Name the dog(s) you are interested in adopting (may list more than one dog or list type of dog you are looking to adopt):*

I am 25 years of age or older?*
Choose one: Yes No

Place of Employment:*

Number of adults in the home including yourself:*

Birth date of Applicant*

Ages of adults:*

Are there children living in the home?*
Choose one: Yes No

Ages of all children (under 18) currently residing in your household:*

Do you or anyone you live with have an allergy to dogs?

Are all family members aware of & approve of adopting a pet?*
Choose one: Yes No

What type of home do you live in?*

Does your housing have any stipulations to owning a dog?

Do you own or rent your home?

Landlord name and phone number is required if renting. If you own a condo or townhouse we need the association name and number.*

Do you have a yard? *
Choose one: Yes No

Is your yard fenced in?

How high is the fence?
Choose one: 1-3 3-4 feet 5-6 feet 6+ NA

What will you do for exercise & bathroom duties?*

Do you have a pool?*
Choose one: Yes No

Is the pool fenced?*
Choose one: Yes No NA

Describe your home atmosphere?*
Choose one: Busy & noisy Some activity Quiet and serene Other

Describe your level of experience with dogs:*

What is the primary reason you want a dog?*

What kind of dog is right for you?*

Dogs need daily exercise. How many times a day will you be able to walk your dog? For how long each time?*

Will there be someone with your pet during the day?*
Choose one: Yes No

Greatest number of hours spent alone during the day: Who will be watching the dog during the day:*

Will there be someone home with your pet during the night?*
Choose one: Yes No

Greatest number of hours spent alone during the night:*

Who will be responsible for the care of the dog?*

How do you feel is the best way to discipline a dog?*

Where will the dog spend most of his time during the day?*

Where will the dog sleep?*

Where will the pet stay while you travel?*

Will you be taking this dog to obedience class?*
Choose one: Yes No

Are you familiar with the use of a dog crate to train/confine the dog during your absence or at night?*
Choose one: Yes No

Do you agree to let a Small Dog Rescue representative do a home visit before and/or after adoption?*
Choose one: Yes No

How much do you think this pet will cost you each year (include food, heartworm preventative, flea control, medical, dental care, supplies, training, grooming, boarding costs)?*

Please list all animals past & present, you’ve owned in the last 5 years. Give the name, sex, age and breed.*

Which are current pets:*

Have you ever given away a pet?*
Choose one: Yes No

Please explain the circumstances:*

Please list two references who are not family members. Include full name and phone numbers:*

Please list the name of your veterinary practice *

Please let your vet and personal references know that they may be receiving a call.

Current veterinarian's name:*

Veterinarian's phone number:*

Past vet name:*

Phone:*

Do you give your current dog heartworm preventative? We would need proof. If you don't have a current dog, did you give your past dog heartworm prevention?*
Choose one: Yes No

Are all of your dogs current on vaccines and spayed/neutered?*
Choose one: Yes No

If not, please list reasons why:*

First available date you will be ready to take ownership of your new family member:*

I have read the above information carefully and have filled out this application honestly. I / we agree that if we adopt a dog, we will provide professional vet care, and a loving home. *We also agree that we will return the dog if we can no longer keep it. *No member of our household has ever been convicted of cruelty to animals. If an omission or untruth is discovered during or after an adoption takes place, I understand that the Small Dog Rescue reserves the right to annul the adoption and reclaim the animal. I also confirm that I have read or been explained the deposit policy for the dog I am applying for. I understand that if any of the information provided in this application or throughout the adoption process is found to have been falsified, my deposit will not be refunded. By submitting this application, I agree to give permission for a representative of SDR to call the references and veterinary practices I have listed. (Please call your vet to okay providing us with this info ) I also understand that every effort will be made for a home visit to be conducted by a SDR representative and furthermore that SDR reserves the right to deny any adoption application with or without disclosure of cause