Congratulations on your decision to adopt and save a life from a shelter! We at Daniel’s Dream Dog Rescue believe that once you adopt from us you become part of our “family”. We will stay in contact with you long after your adoption has been completed so you stay a member of our “family”. Please complete all of the information on the following pages. Your application will be screened and someone from Daniel’s Dream Dog Rescue, Inc. will contact you. Our adoption donation is $300. This donation goes towards various costs pertaining to our rescues (vet visits, spay/neuter vaccines, etc.) but does cover the whole cost. Any additional donations are appreciated!

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First Name* Last Name*
Address*
City*
State*

Zip*
Email Address*
Primary Phone*
Work Phone
Cell Phone

 
Date of Birth* (mm/dd/yyyy)
Name of Current Employer
Address of Employer
Number of years employed:
If currently unemployed, please explain how you would cover the costs of keeping this pet healthy, including ve visits and any boarding.
Why do you want to adopt a dog?*
Are all members of your household in agreement with adopting this dog? If not, please explain:
YesNo
Name and ages of ALL occupants in household (including yourself)?
Name Age
Do you Own or Rent? OwnRent
If renting, you MUST provide the name and number of landlord below.
Landlord Name:
Landlord Phone:
Landlord Address:
Do you have a homeowners or renters insurance policy? YesNo
Name of insurance company:
If you have homeowner's insurance, what are their pet policy restrictions?
How long have you been at your current address?
Do you have a city or county ordinance that limits the number of dogs you are allowed to have in your home?
If yes, how many?
On average how many hours will you have to leave your dog alone during the day?
If you do not have children currently living with you, do you plan on having children or will children be visiting the household? YesNo
Are any members of your household allergic to animals? YesNo
Does anyone other than family/household residents come into your home on a regular basis (i.e. cleaning service)? YesNo
If yes, how will ensure your pet's safety?
List ALL current and past pets including age & breed.
Name of Dog Breed Age
Who is your current or most recent veterinarian?
Name of Veterinarian Address Phone number
If you currently have a dog(s), describe any behavior issues that he/she has.
If you currently have a dog(s), how do they react to new dogs?
Have you had to give up a pet during your lifetime? YesNo
Are your present pets up-to-date on their annual vaccines/wellness checks? YesNo
Are your present pets micro-chipped? YesNo
Are all past/present pets spayed or neutered? YesNo
Please let us how do you plan on exercising your adoption?
Does your home have a fenced in yard? YesNo
If you have a fence, please describe it (height, material, size, etc.).
How much time will your dog spend outside unsupervised?
How far are you willing to travel to meet your adoptable dog?
What breed/type of dog are you interested in?
Age of dog you would consider (check all that apply):
2-12 months1-3 years4-7 years7+ years
If considering a puppy, are you prepared to deal with the following issues: Training, Chewing, Nipping, House Training, Socialization, Crying at night, High Energy Level Yes
Size of dog you prefer (check all that apply):
Small (under 20 lbs) Large (50-100 lbs)Medium (20-50 lbs)X-Large (over 100 lbs)
Energy level of dog you would consider adopting (check all that apply):
Please explain how would you deal with any behavioral issues that may come up.
Please provide 3 references (no family members):
Name Relationship Phone
During the application process, please note that we may be contacting your references, place of employment, landlord, and/or veterinarian. We will also be making a home visit before the application is final.



Please read all of the following:

  • I agree to provide care from this day forward to my new pet.  This includes adequate food, water, exercise, shelter, veterinary care, and lots of love. The pet will be kept in the house and will not be tethered outside.
  • I agree never to sell, trade, or surrender the pet to any agency.
  • I agree that Daniel’s Dream Dog Rescue, Inc. will have first option of reclaiming the pet.
  • I agree that the adoption fee is non-refundable and there is no reimbursement if the adoption does not work out.
  • I agree that all expenses incurred after I take possession of pet will be my sole responsibility and Daniel’s Dream Dog Rescue, Inc. is released of any and all liabilities whether financially or other.
  • I hereby understand that the Daniel’s Dream Dog Rescue, Inc. may have no prior information of age, breed, health issues, training, registration, or other. Any information shared by Daniel’s Dream Dog Rescue, Inc. is of own experience with the pet and Daniel’s Dream Dog Rescue, Inc. makes no warranties of any kind concerning pet.
  • I agree to provide Daniel’s Dream Dog Rescue, Inc., or his/her designate, access to all parts of my home and property for a home inspection before my application to adopt is approved.
  • I agree that I am over 21 years of age.
  • I will not transfer possession or custody of my adoption to any other person at any time, except for temporary, short-term possession for the purpose of vet care, grooming, etc.
  • I agree to contact the Daniel’s Dream Dog Rescue, Inc. with any and all questions or concerns about my adoption.

I have read this Agreement in its entirety and I agree that all statements and stated agreements contained in this document are made by me, and are truthful. I acknowledge that any falsification of the above information is grounds for denial of this application.

Your Full Name
By checking this box I have read and agree to the terms above.
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