Dog Adoption Application Dog Adoption Application Completely fill out and submit the application. If you do not hear back within 10 days, please assume that your application was not selected. Applications that are selected are vet-checked, and personal reference checks will be done as well. If the adoption is approved, an adoption contract will be signed, an adoption fee will be paid, and you take your new pet home. Please give careful consideration to adopting a dog. Be sure that your lifestyle allows the time, patience and expense this pet will need over the years. Be ready for a 10-15 year commitment. Animals are not toys or short-term commitments, and they are NOT disposable.Name* First Last Year Born*Email* Enter Email Confirm Email Primary Phone*Secondary PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Residence Type*Please ChooseHouseCondoApartmentMobile HomeTown HouseOtherIf you live in a condo or mobile home, are you restricted to a specific size/breed dog?*Please ChooseYesNoNot sureNot applicableIf you selected "Other", please explain:Housing Arrangements*Please ChooseOwnRentLive with parent(s)Live with friend(s)OtherIf you selected "Other", please explain:If you are renting, please list your landlord's name and phone number:What kind of fence does your home have?Completely Fenced InLocked EntranceUnderground EntranceNoneIf you rent and have been at your current residence less than 2 years, please list your previous landlord's name and phone number:Please list the names and ages of all family members living in your home:NameAgeRelationship to You Click + to add more rows.Employment and Location:*Are you applying for a particular dog? If so, which one(s)?Will a co-applicant be present? If so, please list their name, age, address, phone number, and e-mail.Do you currently own any pets?*Please ChooseYesNoFor each pet, please list their breed, age, name, year and method they were acquired, vaccine status, if they are declawed, whether they are inside or outside, spayed or neutered, and their vet's name and phone.Have you owned any pets in the past? If so, what happened to them?*Have any of your past pets been killed?YesNoDo you plan to enclose your yard in a fence?*Please ChooseYesNoHave you had any pets in the past that you were the primary caretaker for?*Please ChooseYesNoCaretaker past pet info*BreedNameAgeWhat year did you get this pet?Year deceased or last year you had this pet?Up to date on rabiesUp to date on vaccinesSpayed/neuteredIndoorOutdoor Please list any Veterinarians you may have used within the past 10 years:*NamePhone Number Press + button to add more rowsWill you use the same vet for your new dog?*Please ChooseYesNoHave all family members met, and agreed on this dog?*Please ChooseYesNoPlease explain (agreement):*Where will the dog be spending the majority of its time?Who will be at home during the day and night? If there are periods of time when nobody is home, how many hours will the dog be left alone, and what provisions will be made?If you were to travel, where would your dog stay?*Do you plan to go to a professional dog trainer and/or obedience classes?*Please ChooseYesNoNot SureIf behavioral issues were to arise, how would you handle it?*Are any particular activities planned for the dog? If so, which ones?Will this dog be used as a guard dog?YesNoHave you considered the extra expenses that will come with having a dog, including food, supplies and equipment, toys, training, boarding, heartworm & flea/tick prevention, grooming, and that the cost of maintaining a healthy dog can average $500 - $1000 or more a year?Please ChooseYesNoWould you like more information on pet costs?YesNoHave you ever been cited for a Leash Law or Dog License violation?Please ChooseYesNoAre you aware of your town/city's ordinances regarding dog licensing?*Please ChooseYesNoNot SureAre you aware of any Leash Law in your city/town?*Please ChooseYesNoNot SureIf you had to move suddenly, what would you do with your dog?*Are you willing to take the time to housebreak a dog, and do you understand that changing a dog’s environment may cause the dog to have accidents?*Please ChooseYesNoNot SreIf Yes, how would you do so?Describe the kinds of personal situations where you might have to return your adopted dog:* Shedding Barking Chewing Doesn't Listen Moving Getting married/divorced Kids don't take care of Gets to o big Too expensive New baby Would never consider Other Other (be specific)What steps have you taken to prepare for a new dog?*Do you have or use: Ovehead run? Tie out? Who will care for, train & exercise your new dog?*How will you exercise your dog?*What attributes are important for the dog to have?* Good with dogs Good with cats Good with kids Size Past chewing stage Easy going Not hyper Does not matter Do you have a health preference? Choose Option Healthy Only Healthy w/minor short term problem Healthy w/minor long term problem Disabled Does not matter*Please ChooseHealthy with minor short-term problemHealthy with minor long-term problemDisabledDoes nto matterWhy do you want to rescue a dog?*Any additional interests, or requirements?How did you hear about Rose Hope?Please provide additional information you would like us to know about yourself (breed / rescue experience, etc.):By submitting this application I attest that the information provided is true and accurate and understand false information will result in denial of adoption. Also, if an omission or untruth is discovered after an adoption takes place, the Rose Hope Animal Refuge and Rescue reserves the right to annul the adoption and reclaim the animal. I give permission to fully investigate the information provided as well as contact veterinarians and related officials. The adoption decision is dependent on many factors, including but not limited to the compatibility of the family to the individual animal. I understand it is the Rose Hope Animal Refuge and Rescue prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated I am free to apply and undergo the application process in the future. I, the undersigned, hereby specifically and forever release, discharge and hold harmless the Rose Hope Animal Refuge and Rescue, its agents, and any other person, firm or corporation charged or chargeable with liability, their heirs, administrators, executors, successors and assigns, from any and all claims, damages, costs, expenses, loss of service, actions and causes of action in relation to adoption of the dog. I hereby authorize the Rose Hope Animal Refuge and Rescue the right to receive information from Veterinarians and others listed on this application. MY INITIALS:*By checking this box you have read and agree to the above statements.* I agree EmailThis field is for validation purposes and should be left unchanged.