Adoption Application

Today's date: *

YYYY

Name: *

First Name

Last Name

Age:

Phone Number: *

Email: *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employment: *

Work Schedule: *

Do you: *

Own

Rent

Landlord's name and phone number:

Are there any breed restrictions or weight limits? *

Yes

Will the dog live *

Indoors

Outdoors

Is your yard fenced? *

Yes

If no, how do you plan on confining and exercising the dog? *

Do you have any other pets? *

Yes

If yes, what are they? *

Are all pets up to date on current vaccinations? *

Yes

Are all pets spayed or neutered? *

Yes

Who all lives in your current household *

Do you have children? *

Yes

If yes, please list ages:

Does anyone have known allergies to dogs?

Yes

Name and phone number of veterinarian: *

How many hours will the dog regularly be left alone a day? *

Are you able to keep the dog well socialized and stimulated by going on: *

Regular walks

Car rides

Hiking

Visits with family

Camping

Other

If you experience any behavioral issues with your new dog, do you agree to contact JDR immediately, so that we can help address the issue before they negatively affect the bond you have your dog? *

Yes

Are you willing to take your new dog/puppy to basic obedience classes within the first 3 months of adopting? Obedience classes are a great opportunity to learn your new dog and create a lasting bond, as well as learn some training techniques. *

Yes

Would you be willing to seek out professional assistance from a certified dog trainer if behavioral issues arise that we cannot help you resolve? *

Yes

JDR reserves the right to refuse adoption to anyone whom has a history of neglect, lack of long term commitment to a pet, or to any applicant who does not meet the adoption criteria we have established for a particular dog (all dogs are not well suited for all homes). No dog will be adopted to anyone who misleads or fails to provide accurate information on the adoption application. The right is also reserved to JDR to inspect any property where the dog will reside prior to the final adoption approval. I certify that the information listed above is true and correct to the best of my knowledge, and by signing this application I authorize JDR's permission to verify the same. *

By typing your full name below, this acts as your signature. *

Date *

YYYY

Is there a specific dog in the rescue that has caught your attention?

Dog preferences (Check all that apply): *

Male

Female

Cropped Ears

Natural Ears

Docked Tail

Natural Tail

Black and Tan