First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Cell Phone*

What is the name of the animal that you are interested in? If no specific animal, please give description of the animal, including temperament, gender, breed and adult size that you are interested in. *

Why do you want this pet?

Describe all household members; name, age and relationship to Adopter:*

Does any member of your household have an allergy to dogs?

If you have children, have they lived with a dog before?

Have they been taught to respect pets?_____ If so, how?

Give approximate work/school schedule for household members:

How much time will the animal spend alone during the day?*

Where will the animal be kept when you are not home?*

Would this be your first dog?

If you currently own any pets, please list species, sex, breed, age and tell us where your pets are now.

How do your current pets get along? *

Will your pets accept the new pet? ________ How will you ease the new pet into the household? *

Have you had any pets in the past?

Tell us about your previous pets; include, name, how long you had each pet, what age were they when you got them, how the relationship ended.

Are your current pets sterilized?

Have all your pets been seen yearly by a veterinarian for a wellness exam - including all current and previous pets?

If no, which pets and why not:

Veterinarian's Name, Email address and Phone Number:*

Do you rent or own your home?*

How long have you lived at your current address? *

If you rent, please enter your landlord's name, email address and phone number*

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Please explain any lease or homeowners association pet rules: *

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

Do you have a pool?

How will you let the dog out to eliminate?*

Are there times when the pet will be tied up outside?

How will the pet get exercise? *

Where will your new pet spend most of its time during the day? *

Where will your new pet spend most of its time during the night?*

Will your new pet spend any time in the garage?

Will your new pet spend any time in the basement?

Are pets allowed on furniture?

If you drive a pickup truck, would you allow your pet to ride in the back?

If your new pet is a puppy, will someone be available mid-day to let the puppy out to eliminate and to it feed lunch?

Are you willing to housebreak a dog?

Do you have experience housebreaking a dog?

Are you familiar with crate training:

Are you familiar with crate training a puppy?

If you have done obedience training in the past, tell us when and where.

What activities are you interested in doing with your new pet? *

What food would you or do you feed your pets?*

Do you realize that when you adopt a pet you are making a long term commitment? (Most dogs that are well cared for can live 14 - 18 years)

If you move, will you take the dog with you?

If the newly adopted pet should need veterinary care in the future, would you be willing and able to pay for their operation, hospitalization, medications, etc.?

How much are you willing to spend on medical bills for your dog?
Choose all that apply: Up to $100 Up to $500 Up to $1000 Up to $5000 Whatever it takes

What would you do if the vet bills go over this amount? *

Are you prepared to schedule and pay for regular grooming of the pet? (Long haired dogs should be groomed regularly every 6-8 weeks)

Do you agree to keep ID on your pet at all times?

Under what conditions would you relinquish your pet(s)?
Choose all that apply: Divorce Moving Owner's ill health Chronic illness of pet Expense New baby Pet urinating/defecating inappropriately Other, please explain in Additional Comments below

What provisions will you make for this pet should you become unable to care for it? *

What is our idea of disciplining a dog? *

Are you aware that a rescue dog may have a history of abuse/neglect/unknown treatments and may have behavioral issues that require training, such as house training, toy/food aggression, etc?

Are you willing to provide the extra training, patience, and attention your new pet needs as they adjust to your family?

Are you willing to be dedicated to working through any problems, even if it requires outside help or training?

Please explain any reservations or limitations you may have:*

Any other relevant information or additional comments:

List three personal references including one reference who is not a family member. Provide names, email address and phone number. *

I understand that Save A Friend P.R. (SAFPR) will contact my veterinarian(s), personal references, and, if appropriate, my landlord. I authorize my veterinarian(s) to provide SAFPR with information related to any current or past pets I may have had. I authorize my landlord to provide SAFPR with information relating to the permissibility of housing a pet in my rental unit. Name and Date: *