Gateway Regional Rescue Application for Dog Adoption
Leah Jacobson, President
803 State Rte. 57, Stewartsville, NJ 08886; 201-321-4152
email: website: Facebook.com/grrnj
Thank you so much for considering one of our dogs for adoption! We strive to insure that both the dog and the adopter are happy with the outcome of the adoption. Please fill out the application below so that we can determine whether or not the dog you are interested in will be a good match for you and your household. We are a 501c3, all-volunteer animal rescue and adoption organization.
Name of Dog you wish to Adopt: Date:
Name of Adopter:
Address (street please, no PO Boxes):
Home Phone Number:Work or Cell Number:
Email Address:
Are you 18 years of age or older (age)?
Do you rent or own your home?
If you are renting, please provide the name and contact information for your landlord. This is required before we can process your application.
Have you adopted from us before?
Please list names and ages of everyone who lives in your home:
Do you have other pets in your home? If yes, please list the names, ages and types of pet.
Are all of your current pets spayed or neutered?
Do all of your current pets receive annual wellness exams from your veterinarian?
Please provide the name and contact information of your current veterinarian:
Have you lost a pet recently (in the last five years) or had to give one up for some reason? Please explain:
What are you looking for in a dog?
What behavioral problems do you consider unacceptable?
Please describe your lifestyle and how this animal will fit into your lifestyle:
1)How many hours a day will your dog be home alone?
2)Do you have a fenced in yard?
3)Where will this dog be when you are not at home?
4)How will you insure that this dog receives adequate exercise?
5)Who will care for this dog if you are out of town?
Have you used a book or video to train an animal in the past? Would you consider using a professional trainer?
What would you do if this dog develops a medical or behavioral problem that you cannot handle?
Please provide at least one personal reference (with phone number and/or email address) who is not a family member:
Do you have any questions for us?
I certify that information entered on this application is true (please enter your name and date):