All Herding Breed Dog Rescue

2229 Maple Road Joliet, IL 60432

Lois Carberry/President

NOTE: If you fill out your application online and return it electronically, please contact us at if you have not heard from us in three days time to ensure your application has been received.

Filling out an application does not guarantee adoption of one of our animals, but we do not adopt out any dog without this form completed and a contract signed.

Dog’s name: Breed/mix:

Primary reason for this adoption:

CONTACT INFORMATION:

Your name:

Address:

Primary email address:

Home number:

Cell:

Are you over the age of 21? Current Age:

Spouse/partner/roommate name: Current Age:

Ages of children in your home or who visit regularly:

Is everyone in your home in favor of this adoption?

Are you employed? (Where and for how long):

Work number:

Do you rent or own?

Landlord’s name and number, if applicable:

PET HISTORY INFORMATION:

If you currently have pets, or have ever owned pets, please complete the following:

Veterinarian:Phone:Address:

How many other pets do you currently own?

Dogs:Cats:Avian/reptile:Other:

Where did your current pets come from?

Have you ever had to give a pet away?

If yes, what were the circumstances?

Are your pets up to date on: Vaccinations:Heartworm prevention:

Are your pets spayed/neutered?

If not, why?

If you have previously owned other pets, what happened to your last 3 pets? (List type, age, and circumstances for which you no longer own this pet)

Pet 1:

Pet 2:

Pet 3:

NEW PET ADOPTION QUESTIONS:

Are you familiar with the breed/mix of breeds of the dog you are interested in adopting?

If yes, please explain what you know:

Where will your new dog spend his/her time during the day?

Where will your new dog spend his/her time during the evening?

Where will your new pet spend his/her time when you are out of town?

How long will your dog be alone, on average, without a potty break?

Do you own or plan to buy a crate?

If you don’t plan on crating, how will you keep your dog contained while you aren’t available to supervise him/her?

Do you have a fenced in yard?

  • If yes, how high?
  • Is it fully or partially fenced?
  • Is it an electric fence?
  • Is it a wooden fence or chain link?

If you don’t have a fence, how will you keep your dog in close proximity?

-Continued-

Please list reasons why you would NOT keep a dog:

Other (please list):

Please answer the following questions:

Are you willing to work on basic obedience, which may include going to obedience training?

What brand of food do you plan to feed your new dog?

In the event you become unable to care for this dog, who will care for him/her?

Are you prepared for the financial obligations of owning a dog, including but not limited to: food, shelter, obedience training, vet visits, medications and grooming?

Would you allow us to do a home inspection prior to adoption?

Do you understand that, even though vaccinated, we cannot guarantee the health or temperament of any dog adopted through our organization?

Do you understand that if you have children in your home, dogs and children must be supervised at all times?

Do you agree to care for this dog and provide food, water, medical care, grooming, indoor housing, and companionship for the rest of his/her life as long as you are capable?

Do you understand it is required by your contract to provide monthly flea/tick and heartworm prevention to your dog every month unless otherwise directed by your veterinarian?

Do you understand that this dog is a pet, and that if you cannot keep the dog you will immediately contact AHBD to arrange for the dog to be picked up/dropped off at a specified location?

Do you understand if the dog must be returned and you cannot provide proof of current vaccinations and/or heartworm prevention, you will be charged a $25.00 owner surrender fee for the dog?

Do you understand it might take weeks to accept the dog back into foster care and that it is your responsibility to care for this dog until a foster home can be found?

Have you or anyone in your household been convicted of a crime against animals or children?

* Please provide the name, email address and phone number of two (2) references. / Relative Reference

Non-Relative Reference

-Continued-

I declare that the information I have provided in this application is complete and correct. I further declare that I am financially and physically able to care for a rescued dog. I understand that proper food and veterinarian care may be costly, and I am able and willing to meet the needs of my adoptive dog. I understand the requirements and grant permission for Home Checks at random both prior to and following adoption. I submit that if the Adoption Application or the Home Check reveals falsification or misrepresentation of any facts on my part, All Herding Breed Dog Rescue of Illinois reserves the right to either refuse adoption or to nullify the adoption and reclaim said rescued dog from my premises, without reimbursement of the adoption donation. I release All Herding Breed Dog Rescue of Illinois from any liabilities I may incur from the adoption process.
By submitting this application you are agreeing to the above declaration.
* Please print your name again, to be used as a signature on this form. / Signature:

Date:

Email this application to :

Please give us 48 to 64 hours to reply to your application

Thank you for considering the rescue dog you applied for today!