/ Tri-Valley Animal Rescue DOG Adoption Application
Name of dog you’re interested in:

Family Information

Name: / CITY
Address: / ZIP
Is the residence address listed above the location where your new dog will be living? / Yes / No
Phone: / home / work / mobile
Email:
Names and ages of everyone in household
Why are you getting a dog?
Is everyone in your household in favor of adopting a dog?
Housing: / Own / Rent / Live with parents
Type: / House / Condo / Apartment / Mobile home
What is your household activity level? / Low / Moderate / Active / Very active

If you rent your home the following is required:

Landlord’s name: / Phone:
Is your landlord aware that you may be adopting a dog, and have they approved it? / Yes / No

If you currently own any other pets, the following is required:

Please list any other pets that currently live with you, including age, species/breed, sex, and if they are altered.
Has(Have) your current dog(s) been introduced to the dog you are considering adopting? / Yes / No

Dog Living Arrangements and Care

Will the dog be: / Indoors / Outdoors / Indoor/Outdoor / Dog run
Where will the dog sleep? / Inside / Garage / Outside / Other (explain)
Who will be responsible for feeding the dog each day?
How many hours per day will the dog be alone? / 0-2 / 2-4 / 4-6 / 6-8 / Over 8
Where will the dog stay when you are not home? / House / Garage / Outside / Other (explain)
Will the dog be left unattended with children? / Yes / No / If yes, please explain
Who will take care of your dog while you are on vacation?
If you must re-locate, what will you do with your dog?
Most dogs require regular exercise. Who will provide this?
In what family activities will your dog be included?
What activity level would you like your dog to have? / Low / Moderate / Active / Very Active
Are you getting a dog for protection? / Yes / No / If yes, please explain

Is anyone in your family allergic to pets? If so please describe

Do you have a fenced yard? / Yes / No / If yes, how tall is the fence in feet?
Does the fence need repairs? / Yes / No / If yes, please explain
Will you chain the dog in the yard? / Yes / No / If yes, why/how often?
Would you agree to having your property inspected to make sure it’s safe for your dog? / Yes / No
How will you prevent the dog from getting fleas?

What type of identification will your dog wear? ______

Dog Specifications

Is this dog a gift? / Yes / No / If yes, who is the dog for?
Have you (or the recipient if the dog is a gift) ever owned a dog before? / Yes / No
What happened to the dog? / Deceased / Lost / Gave away / Other (explain)

Dog Specifications (cont’d)

What breed(s) of dog interest(s) you? / Are you familiar with the(se) breed(s)? / Yes / No
What age(s) interest(s) you? / Puppy (<1 yr) / Young (1-3 yrs) / Adult (3-8 yrs) / Senior (> 8 yrs)
What size(s) interest(s) you? / Sm (<30lbs) / Med (30-65lbs) / Lg (65-120lbs) / Giant (> 120lbs)
What coat types are acceptable? / Long / Medium / Short / Regular grooming required is OK

Training

Have you ever attended a dog or puppy obedience class or a behavioral class? / Yes / No
If yes, please list the classes and dates you attended them
Do you plan to take your dog to an obedience class? / Yes / No
If no, why not?
Who will be responsible for training your new pet?
What techniques and equipment will you use to train your pet?
How do you plan to socialize your dog?

Please describe what you would do if your dog develops any of the following behavior problems: barking, chewing, digging, aggression, inappropriate urination in the house

Costs

There are ongoing costs associated with owning a dog. Are you willing and financially able to provide the following for your dog for its entire life? (Note: costs provided below are average costs. Your actual costs may be higher or lower) $60-$150 FOR INITIAL VET CARE; $50 -$200 for initial obedience training; $25-$100 + per month for food; $150 + for yearly veterinary care and vaccines; $20 + for annual county licensing fees; $500 + for special vet care needs.

I understand that my dog will cost on average $800 to over $1,100 or more per year / Yes / No

If the dog needs to be returned, the adoption fee may be refunded with the first two weeks, depending on circumstances. Please note that space may not be available with the original foster or an alternate foster and you, as the owner, may need to foster, board or rehome the dog yourself if we cannot find a new home for it.

Please acknowledge your understanding / Initial / Date

References

May we contact your veterinarian for a reference? / Yes / No
Veterinarian’s name: / Phone:
If no, why not?

Acknowledgement of Responsibility

Adopting a dog is a tremendous responsibility. You will be sharing your life with this dog for up to 15 years or more, and during this time the dog will be completely dependent on you for food, shelter, cleanup, and veterinary care. Please initial each of the statements below indicating you accept them.

I am/We are ready to make a LIFETIME commitment to our new dog
I/We will give our dog daily companionship, and not just when it’s convenient
I/We understand that if we return the dog, we will be responsible for its care until a new home is found
I/We are willing and financially able to care for the dog as described in the Costs section above
Signature: / Date: