First name:
Last name:
Address:
City:
State:
Zip:
Phone:
(home) (work) (cell)
Email:
Age:
Occupation:
What kind of dog are you looking for?
Age range:
to
Sex:
Male Female Doesn't matter
Size:
Breed mix:
Coloring:
Temperament:
Other:
Would you like to be considered for a specific "Wagging Tails" dog? Yes No If so, which one?
How long have you been looking for a new pet?
Where have you looked previously?
Why do you want a new pet?
Is this dog going to be a gift? Yes No If so, for whom?
Would you consider adopting a special needs dog? Yes No Maybe (Examples: daily medication, blind, deaf, etc.)
If we found two dogs already together, would you consider adopting more than one dog? Yes No
How many other adults live in your home? What are their relationships to you?
How many children live in, or visit, your home? What are their ages?
Who will be primarily responsible for the care of your new dog?
Is anyone in your home allergic to dogs? Yes No If so, please describe.
Does anyone in your home fear dogs? Yes No If so, how will you deal with this situation?
What type of neighborhood do you live in? Urban Suburban Rural Other If Other, please specify:
What type of residence do you live in? House Apartment Condo Trailer Other If Other, please specify:
Do you rent or own your home? Rent Own
If you rent, do you have the permission of your landlord to have a dog? Yes No
Landlord's name:
Are planning a change of residence in the near future? Yes No
If you were forced to move, what would you do with your dog?
Do you have a yard? Yes No Approximate size:
Is your yard fenced? Yes No Type of fencing: Stockade Plank/Picket Post & Beam Chain Link Invisible/Wireless Other:
Height of physical fencing, if applicable: Approximate size of enclosed area:
Do you have a pool? Yes No Is it fenced? Yes No
Your current vet, or vet most recently used within the last ten years (if any):
Your vet's name:
Clinic name:
Please list all pets who currently live in your home.
Name: Type/Breed:
Sex: M F Age: Altered: Yes No
Date of last vet visit: Date of adoption:
List additional pets in the "Additional Information" section, below.
Please list all other pets you have owned in the past ten years.
Sex: M F Altered: Yes No
Dates of ownership:
What happened to this pet:
Please consider carefully and answer all the following questions about how you would care for your new dog.
As a general rule, how many hours each day will your new pet be left alone?
Where will s/he be kept when you are not at home?
Will your new pet be crated? How many hours each day?
How long per day will the dog be outside?
Will the dog be outside with supervision, or alone?
Where will the dog sleep at night?
Will the dog ever be kept outside overnight?
How will you exercise your new family member in good weather?
How will you exercise your new family member in winter/bad weather?
If your yard is not fenced, will you allow your dog to run loose in the yard? Yes No
If you rent, where will your dog be allowed to eliminate?
How many times a day would you feed your new pet?
Who will care for your pet when you are on vacation? Family Friend Kennel Pet/House Sitter Other: Please provide name and phone number:
Do you believe animals should be vaccinated?
Are you familiar with the medical responsibilities that accompany a pet? Please describe.
Under what circumstances do you feel animals should be taken to the veterinarian?
Who will assume the financial responsibility for your new pet? This includes but is not limited to reasonable veterinary care including annual check-ups and inoculations, quality food, and licensing.
Are you familiar with the animal laws and regulations in your area? Yes No Do you need us to get you this information? Yes No
Have you ever done training with your current or previous pets? Yes No If so, please provide the name of the trainer/facility and when:
Are you willing to take your animal to obedience or agility training classes if recommended by our staff? Yes No
Do you understand that a rescue dog may take considerable time and effort to adjust to a new home and new situations? Yes No
What do you consider a reasonable amount of time for your pet to adjust?
What will you do to help your new dog adjust? (besides love and affection)
Have you ever surrendered a pet? Yes No If so, why?
What types of circumstances (either personal or related to a dog's behavior) might cause you to surrender your pet?
What will you do if your present pet(s) doesn't get along with your new pet?
Please supply two personal references (friends, neighbors, co-workers, etc.—NOT a family member).
Reference # 1 name:
Relationship to you:
Reference # 2 name:
If you would like to add anything to this application that hasn't been covered above, please do so here:
I attest that the information above is true and correct. I understand that falsification of any of the above information is grounds to disallow the adoption of a rescued dog.
I attest that I am financially and physically able to care for a dog.
I understand that my landlord and/or veterinarian (as applicable) may be contacted to verify the relevant information above. I agree to allow a home visit from a Wagging Tails Dog Rescue placement coordinator, by appointment.
I understand that I may not transfer ownership of any animal adopted from this rescue to another party. If for any reason I cannot keep this pet, it must be returned to "Wagging Tails Dog Rescue."
Initials: Date:
If Yes, in which of the following ways?
Foster Care Transportation Home Visits
Telephone Computer Grooming
