Guardian Rescue
Adoption Application
Guardian Rescue reserves the right to refuse placement of our dogs for any reason. All homes are screened thoroughly for suitability for both the dog & the adopters. By filling out this application, you agree to grant us the right to verify any statement or information filled out below. Please initial here __________ to verify that you have read the above statement. Name:_______________________________ Phone #’s: Hm_____________________ Address:_____________________________ Wk_____________________ City, State, Zip:________________________ Cell____________________ E-mail:__________________________________________________________________ Employer: _______________________________________________________________ Address:_________________________City:_______________State:___Zip:__________ Phone:______________________________ Employer:(Spouse/other caretaker)___________________________________________ Address:_________________________City:_______________State:___Zip:__________ Phone:______________________________ Name of dog specifically interested in:________________________________________ The following questions are geared to help us help you find a good match for your needs. Please mark the following from 1-10 with 10 very important & 1 not important: ______Friendly ______Protective ______Playful ______Cute/Pretty ______Housebroken ______Obedience Trained ______Crate Trained ______Good with dogs ______Good with cats ______Good w/kids 5-under ______Rides well in car ______Good w/kids 5-up Please list in detail any reason(s) that you feel would warrant giving up your pet: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What made you decide to get a dog?__________________________________________ Where would this dog primarily be kept?_______________________________________ During the day:________________ At night:________________ When alone:_________ Have you had dogs in the past? Yes ____ No ____ Do you: ___Own ___Rent a: ___House ___apartment ___townhome ___mobile home ___other-explain_________ Do you have a fenced yard:______ How high?________ What type?_______________ Please list all animals currently in the household: Dog/cat/other Breed Age Sex Owned how long ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Are all of your animals spayed/neutered? _______ If no, please explain?_____________ ________________________________________________________________________ Are you willing to have your animals spayed/neutered? __________________________ Are all of your animals currently up to date on shots? _____ If no, please explain:______ ________________________________________________________________________ Are you aware of the need for heartworm preventative? _____ Are all of your animals on heartworm preventative? ______If so, what brand?_________ Are your animals treated for fleas/ticks?______ If so, what brand?__________________ How often do you administer the Heartworm preventative? _______ Flea/Tick?________ Please list below any animals not listed on the previous page you’ve had for the last 5 years, and why they are no longer with you: Dog/Cat/Other Breed Age Sex Reason _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ If deceased, please list cause if known in the following space: ______________________ ________________________________________________________________________ Please list your veterinarian:_________________________________________________ City/State:______________________________ Phone#:__________________________ If animals are under a name other than yours, please list the name they are under:_______ ________________________________________________________________________ If you have more than one veterinarian, please list the additional information on the reverse side of the application. Check here to indicate addt’l info: __________________ Please list 2 personal references: Name, City/State & Phone Number 1._____________________________________________________________________ 2._____________________________________________________________________ How many people live in the home?_______ Adults_______ Children_______ Ages of children________ Is anyone in the household allergic to dogs?______ Who will be the primary caretaker of this dog?__________________________________ If you had to travel, who would take care of this dog?_____________________________ If you relocated, what would happen to your dog?________________________________ If renting: Does your landlord permit pets?_________ Is there a pet deposit?_____________ If yes, how much?________ Are there any restrictions (size/weight/breed)____________ ________________________________________________________________________ Please list your landlords Name:________________________ Phone:_______________ _______________________________ _______________ Signature date |
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Please print & either scan & e-mail it to - info@guardianrescue.org or Fax it to 509)357-6555 attn: Guardian Rescue. If you cannot print & fax, please click here to Request an Application |
