Dog Adoption Application

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Adoption

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Default: Adopter Status
First Name*
Last Name*
Do You Have A Preferred Dog?
Select Dog
Note: This does not guarantee this dog will be placed with you
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Age Range*
Select Age Range
eMail Address*
eMail Address Confirm eMail Address
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Address*
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
Select State
ZIP*
Phone*
How Did You Hear About Us?*
Select Method
Below are three areas for information on other members of your family. Please include all other adults, children and pets living in your home by clicking on the designated button.
- Are There Other Adults In The Home?*
  - Yes
  - No
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  Add Adults
  
  First Name Last Name Age Range Are They Employed? Actions
  
  There are no Adults.
  
  Maximum number of adults reached.
- Are There Children In The Home?*
  - Yes
  - No
- Ages*
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  Add Children
  
  Age Actions
  
  There are no Children.
  
  Maximum number of children reached.
- Do You Have a Dog(s)?*
  - Yes
  - No
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  Names/Ages*
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  Dogs Spayed/Neutered*
  - Yes
  - No
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  Dogs Up-To-Date On Shots*
  - Yes
  - No
- Add Dogs
  
  Name Age Range Actions
  
  There are no Dogs.
  
  Maximum number of dogs reached.
- Do You Have Other Pets?*
  - Yes
  - No
- Kind*
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  Add Pets
  
  Pet's Name Animal Type Actions
  
  There are no Pets.
  
  Maximum number of pets reached.
Type of Residence*
Select Residence Type
Do You*
Own/Rent?
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Does Landlord Allow Dogs?*
- Yes
- No
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Please Provide Landlord's Name*
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Please Provide Landlord's Phone Number*
- Do You Have A Yard?*
  - Yes
  - No
- Is The Yard Fenced?*
  - Yes
  - No
- How High Is The Fence?*
- What Material Is The Fence Made From?*
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  Please Describe Fence Material*
- Are You WIlling To Take Responsibility For This Dog For The Next 10-15 Years?*
  - Yes
  - No
Are You Capable of Providing Timely Healthcare?*
- Yes
- No
Where Will The Dog Sleep?*
Select Location
Where Will Dog Be Kept When You Are Not Home?*
Select Location
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Please Describe Where The Dog Will Be*
How Long Will Dog Be Alone At One Time Typically?*
Select Timeframe
Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Animals Are Present. Are You Willing To Donate This Much Time To Make Dog Comfortable In Your Home?*
- Yes
- No
Personal Reference 1.
Name*
Phone*
Personal Reference 2.
Name*
Phone*
Personal Reference 3.
Name*
Phone*
Veterinarian Information
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Have You Used A Veterinarian Before?*
- Yes
- No
Name*
Phone*
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When Will You Be Ready To Adopt?*
Select Timeframe
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Is There Anything Else You Would Like to Let Us Know?
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I am interested in receiving pet related services and products*
- Yes
- No
Authorization
I understand that any dog placed with me will be placed as a "Foster to Adopt," until adoption contract is finalized.*
- I agree
I understand that even though my pets are current on vaccinations, there is still a chance that a foster to adopt dog may cause my pets to become ill.*
- I agree
I understand that ALL foster to adopt dogs remain the property of DITRRMO until adoption is finalized.*
- I agree
I agree to not release my foster to adopt dog to ANY person unless approved by a DITRR board member*
- I agree
I understand that DITRRMO cannot be held responsible for any harm or damages that the pet would cause to a person, residence, other animals, or any belongings.*
- I agree
I agree to follow all rules and regulations and I understand failure to do so may result in the removal of my foster to adopt dog.*
- I agree
I agree to ensure the safety and security of my foster to adopt dog at all times and will ensure its health and stability.*
- I agree
I understand that until my foster to adopt dog's adoption is finalized that all shots, medical care, and spay/neutering decisions will be made by DITRRMO.*
- I agree
I agree to supervise my foster to adopt dog in a public setting and follow guidelines about public outings for puppies*
- I agree
I agree to return my foster to adopt dog to DITRRMO if, for any reason, I am unable to provide for its care.*
- I agree
If I take my foster to adopt dog to an unapproved vet, I understand I will be fully responsible for the costs incurred.*
- I agree
I will not sell, re-home, flip, or adopt out my foster to adopt dog to another person or organization.*
- I agree
I agree to ensure my foster to adopt dog is present for any and all shot/vetting appointments scheduled by DITRRMO, and all understand my foster to adopt dog must be altered at the time provided by DITRRMO*
- I agree
I understand that failure to show up for any vet appointment may result in immediate revocation of my foster to adopt dog and I agree to promptly return the dog to DITRRMO upon request.*
- I agree
I understand that DITRR cannot be held responsible for any harm or damages that the pet would cause to me, my family, my residence, my pets, or my belongings?*
- I agree
I understand that the failure to show up for any vet appointment will result in the immediate revocation of my foster/foster to adopt dog and we will make arrangements to do so immediately.*
- I agree
I understand that even though my pets are current on vaccinations, there is still a chance that a foster/foster to adopt animal may cause my pets to become ill*
- I agree
I understand that ALL foster/foster to Adopt dogs are property of DITRRMO and they are to be returned to DITRR upon request. ADOPTIONS ARE NOT FINAL UNTIL ALL VETTING IS COMPLETED*
- I agree
I agree to not release any DITRRMO animal to ANY person unless approved by a DITRR board member*
- I agree
I understand that DITRRMO cannot be held responsible for any harm or damages that the pet would cause to me, my residence, my pets, or my belongings?*
- I agree
I agree to follow all rules & regulations and I understand failure to do so may result in my loss of ability to foster/adopt through DITRR*
- I agree
I have discussed the requirements of being a foster/foster to adopt family with DITRR Board Member/Foster or Adoption Coordinator and have been given the ability to voice any questions and concerns I may have*
- I agree
I will ensure the safety and security of my foster/foster to adopt dog at all times above all else & will strive to ensure health & stability*
- I agree
I understand needs of my foster/foster to adopt dog and do so promise to ensure they are met at all times*
- I agree
I understand that until my foster/foster to adopt dog is adopted all vetting decisions will be made by DITRR not me*
- I agree
I agree to only allow my foster dog in a public setting under MY SUPERVISION unless otherwise approved by a DITRR Board Member (PUPPIES MUST BE APPROVED BY BOARD MEMBER FOR PUBLIC OUTINGS)*
- I agree
If for any reason I can no longer care for my foster/foster to adopt dog, I will alert DITRR as soon as this becomes known to me to make arrangements to return the pet*
- I agree
If for any reason I can no longer care for my foster/foster to adopt dog, I will alert DITRR as soon as this becomes known to me to make arrangements to return the pet*
- I agree
If I take my foster/foster to adopt animal to any veterinarian for any reason without prior authorization I understand that I am fully responsible for all costs incurred from said veterinarian visit*
- I agree
I will not sell, re-home, flip, adopt out my foster/foster to adopt dog to another person without prior authorization from a DITRR Representative*
- I agree
I agree to ensure my foster to adopt dog will present for any & all shot/vetting appointments made by DITRR and that I cannot chose to have my foster/foster to adopt dog not get altered at time provided by a DITRR Board Member. I also understand this is NON-NEGOTIABLE*
- I agree
I understand that failure to show up for any vet appointment will result in immediate revocation of my foster/foster to adopt dog and will make arrangements to do so accordingly.*
- I agree
I understand that regardless of the situation I will not hold DITRR or any associate of DITRR liable for the actions of my foster/foster to adopt dog.*
- I agree
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  Signature*
Email
This field is for validation purposes and should be left unchanged.

Adoption

Personal Reference 1.

Personal Reference 2.

Personal Reference 3.

Veterinarian Information

Authorization

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