Dog Adoption Screening Form | The Shelter Animal Project

The purpose of this application is to place the Dog in what we feel is the best suitable home. We Reserve the Right to Refuse Any Application.

Incomplete applications will not be reviewed, and applications with false information will be denied.

Name*

Occupation

Age

Phone Number*

Employer

E-mail:*

How long there

Spouse/Partner

Occupation

Please add me to your mailing list

Age

Employer

E-mail

How long there

1/6

Name of dog you're interested in

Why this particular dog?

How long have you been looking for a dog?

Where will the dog be over night?

Where will the dog be left when he/she is alone?

How many hours will the dog be left alone?

Who will be responsible for caring for this dog?

2/6

Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

Do you live in an apartment?

Name of Apartment Complex

Phone Number for Office of Complex

Area Code

Phone Number

Dose the complex allow dogs?

Are there any restrictions for the pets allowed (weight, breed, etc)?

Do you live in a CONDO/TOWNHO-- USE

Do you OWN or RENT the CONDO/TOWNHO-- USE?

Own

Rent

Name and Phone Number Landlord/Association

Dose the Association allow dogs?

Are there any restrictions for the pets allowed (weight, breed, etc.)?

Do you have the landlord's permission to have a dog in landlord's residence?

Do you live in a PRIVATE HOME

Do you OWN or RENT the home?

Own

Rent

Does the home's landlord allow pets?

Do you have the landlord's permission to have a dog in landlord's residence ?

Name and Phone Number of Landlord

All homeowners are responsible for contacting their homeowners insurance and informing them they have added a dog to their residence. By checking YES you are legally and willingly agreeing to contact your homeowners' insurance if you are approved to adopt one of our dogs and notify them.

Do you agree to contact your homeowners' insurance?

Do you have a fenced yard?

Is it a full fence?

Fence Height

Do you have any plans on moving in the near future?

3/6

Number of Adults in the household

Number of Children in the household

Ages of children

Name of persons living in the household over age 18, their relationship to you, and their ages (DO NOT include spouse/partner listed on page 1 of this application)

Do you consent to an in-home visit from a Shelter Animal Project Member?

Does any household member have Animal Related Allergies?

4/6

NAME, PHONE NUMBER and RELATIONSHIP of 2 personal references (no relatives)

Reference 1

Reference 2

How did you hear about our organization?

%89 - Since our animals have unknown medical backgrounds, are you prepared to take your new dog for a complete veterinary exam within 2 weeks of adoption, and to provide any necessary medical treatment at your own expense?%

%90 - Do you agree to provide your newly adopted dog with yearly vaccinations and remain up to date with all vaccinations for the life span of the dog? %

6/6