Fill out the online form below or download a PDF to print out. Dog and Puppy Adoption Application Step 1 of 3 33% HiddenDate MM slash DD slash YYYY Name of Adopter First Last Address (no PO Box) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneEmail Driver's License # Employer Work PhoneAre you 21 or older? Yes No Names of Other Adults in Household Have all adults in the household given consent to adopt a cat? Yes No Does anyone in the household have allergies? Yes No Number of Children in Household Ages Length of Time at Address? Do You Live in a(n): House Condo Apartment Mobile Home Boat With parents Size Restrictions? Yes No Explain Landlord Name and Phone OK to call? Yes No How did you hear about our adoption program? Current veterinarian? MICROCHIP REGISTRATIONAll pets adopted through ASR Rescue are microchipped using 24PetWatch microchips. 24Petwatch requires the following information to register your pet. Closest relative/friend who would know how to contact you:Name First Last Phone PET HISTORYCURRENT PETSNameType/BreedAgeSexAltered (Yes/No)Lives Inside, Outside, BothHow long have you been caring for this pet? Add RemovePAST PETSNameType/BreedAgeSexAltered (Yes/No)Lives Inside, Outside, BothHow long have you been caring for this pet? Add RemoveDog experience: First time guardian Had dogs as a child Have had one or two dogs in lifetime Knowledgeable and experienced Have you ever had to surrender a pet to a(n): Animal shelter Friend Family member Animal rescue Other N/A Please explain:If something unforeseen should happen to you, do you have a plan for your animals? Please explain:Do you have a plan for medical care for your animals? Please explain: YOUR IDEAL DOGAdult Size: 0-20 lbs 21-50 lbs 51-100 lbs Over 100 lbs Age: 8-16 weeks 4-12 months 1-3 years 4+ years No Preference Sex Male Female No preference Coat: Short Medium Long Non-shedding No Preference My dog should have experience living with: Cats Dogs Children Other During the day our dog will be: Indoors Indoors / outdoors Outdoors In / out doggie door Garage/run When home alone our dog will be: In a fenced yard Inside the house In and out/doggie door On a runner Garage Crate During the night our dog will be: In the house In / out doggie door Backyard Crate Garage In our bed Training: None is OK Prefer housetrained Some obedience training Fully trained Exercise requirement: Low Medium High Please describe the ideal dog to fit into your lifestyle:The above information is true and correct to the best of my knowledge. I understand that Animal Shelter Relief Rescue reserves the right to deny any adoption.Check to sign I agree to sign electronically Signature Date MM slash DD slash YYYY Upload IDAccepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.
