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PAWS, HOOFS & CLAWS
ANIMAL RESCUE & SANCTUARY
Email: Gloria@ghkbooks.com
Dog
Adoption Application
Name_________________________________________ Home
Phone____________________________
Address_______________________________________ Work
Phone____________________________
City_____________ State ________ Zip _____________ Cell
Phone____________________________
E-Mail Address (s)________________________________________ &
________________________________________________
LOCAL Personal References: (if possible please list one relative not
living with you)
1)Name_________________________________ Phone____________________
Relationship____________________
2)Name_________________________________ Phone____________________
Relationship____________________
How did you hear about Us?
_____________________________________________________________
Name of dog you want to adopt ________________________ or
___________________________________
To ensure that this adoption is in the best interest of both you and the
dog you selected, we ask that you answer the following questions:
1) Do you live in (select one): House___ Apartment___ Condo/Townhome___
Trailer___ Other___
2) Do you: Own____ Rent/Lease____ Name of Complex & Office Phone
#__________________________
3) Are you planning to move in the next six months? Yes_____ No _____
4) What will happen to this dog if you move
unexpectedly?________________________________________
5) What will happen to this dog when you go on vacation or in case of an
emergency?__________________
6) How many hours during the average day will your dog be without a
human?_______
7) Do you want this dog to be (select one): Inside only____ Outside
only____ Both____
8) Where will this dog be kept during the
day?___________________________________________________
Night? ________________________________ When you’re not home?
___________________________
9) Does your home have a dog door? Yes____ No_____
10) Do you have a fenced-in back yard? Yes ____ No _____
If your yard is fenced be sure to check for gaps and weaknesses in the
fencing before bringing your dog home.
If you are adopting a large dog consider if your fence is tall enough (6
ft).
11) Does your gate have a lock? Yes___ No____ If not could one be put
on? ________
(Gates should always be locked so the dog cannot be let loose by
neighborhood kids or utility service people.)
12) If there is no fenced yard how will you exercise the dog?
_________________________________________
13) If the yard is not fenced who will walk the dog and how often will
you take the dog out?________________
__________________________________________________________________________________________
14) What type of vehicle do you own? ________________ If you have a
truck how will your dog be transported?
__________________________________________________________________________________________
15) Please tell us why you would like to adopt a dog?
_______________________________________________
__________________________________________________________________________________________
16) I am adopting this dog for (check all that apply): myself___
spouse___ children___ gift____ other__ (please explain)
___________________________________________________________________________________________
17) Please list below all the people your dog will be living with
(including yourself):
Name Age Relationship to prospective adopter
_____________________________ _______
___APPLICANT___________________________
_____________________________ _______
_________________________________________
_____________________________ _______
_________________________________________
_____________________________ _______
_________________________________________
18) Did your entire family agree on the adoption of this one dog?
Yes____ No _____
19) Will the whole family share in the care of this dog? Yes_____ No
_____
20) Is there any member of your household who is allergic to dogs? Yes
____ No ____
21) Are there any children that visit your home frequently? Yes _____
No_____
If Yes, ages: ___________________________________________________
22) Are there any regular visitors to your home, human or animal, with
which your new dog must get along?
Yes___ No___ If Yes,
Describe:_________________________________________________________
23) Do you have any other pets living with you now? Yes___ No___ If Yes,
please list below:
Type (dog, cat, etc.) Breed Neutered/ Owned for how long?
Spayed?
_______________ ______________________ ______ _______________________
_______________ ______________________ ______ _______________________
_______________ ______________________ ______ _______________________
24) Have you had pets in the past? Yes____ No_____ If Yes, please list
below:
Type (dog, cat, etc.) Breed Neutered/ Owned for Where is the pet now?
Spayed? how long?
_______________ ________________ _______ _______ _______________________
_______________ ________________ _______ _______ _______________________
_______________ ________________ _______ _______ _______________________
25) Do you have a regular veterinarian? Yes _____ No ______
Clinic name, address, and phone number
_____________________________________________
26) May we have your permission to request information from your
veterinarian? Yes _____ No ___
27) How often do you feel a dog should see a veterinarian?
_________________________________
28) What do you know about heartworms?
______________________________________________
29) What will you feed your new dog?
_________________________________________________
30) What kind of behavior do you find unacceptable?
______________________________________
_____________________________________________________________________________
31) If the dog has problems with behavior what will you do about it?
__________________________
_____________________________________________________________________________
I certify that the above information is true and understand that false
information may result in nullifying this adoption.
Applicant’s Signature ______________________________________________
Date_____________
WE RESERVE THE RIGHT TO REFUSE AN ADOPTION!
Thank you for completing the Dog Adoption Application. Please return it
to an adoption counselor so that we may review it with you. The entire
adoption procedure usually takes about a week.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ADOPTION STAFF ONLY
~~~~~~~~~~~~~~~~~~~~~~~~~~
Adopter’s Texas Drivers License
#______________________________________________________
Comments:_________________________________________________________________________
__________________________________________________________________________________
Results (select one) A____ D____ Staff:________________________________
Date_________
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