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Dog Adoption Application

Adoption

Hidden
Default: Adopter Status
First Name*
Last Name*
Do You Have A Preferred Dog?
Note: This does not guarantee this dog will be placed with you
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Age Range*
eMail Address*
eMail Address Confirm eMail Address
Address*
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Street Address*
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Suite | Apt or Unit Number
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City*
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State/Province*
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ZIP*
Phone*
How Did You Hear About Us?*
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*
- Hidden
  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*
Do You*
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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?*
- Hidden
  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?*
Where Will Dog Be Kept When You Are Not Home?*
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Please Describe Where The Dog Will Be*
How Long Will Dog Be Alone At One Time Typically?*
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?*
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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
- Hidden
  Signature*
Phone
This field is for validation purposes and should be left unchanged.

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Add Adults in Adopter Form

First Name*
Last Name*
Age Range*
Gender*
- Relationship To Applicant*
- Please Describe*
- Phone Number*
eMail Address*
- Are They Employed?*
  - Yes
  - No
  - Retired
- Full or Part Time?*
- Name of Employer
- How Long Employed There?
- Are They in School?*
  - Yes
  - No
- Full or Part Time?*

Add Children

Age*

Add dogs in the house.

Name*
Age Range*
Dogs Spayed/Neutered*
Dogs Up-To-Date On Shots*
- Yes
- No

Add other pets in the house.

Pet's Name*
Animal Type*
Is There Any Additional Information You Would Like to Add?