Adoption Application

1. YOUR FAMILY AND NEIGHBORS:
Are there other adults in your household? YES     NO     (Please circle answer)
Their ages:

Do they agree with your decision to get a dog?      YES         NO
If not, what reason do they have for not wanting a dog now?

Are there children in your household?        YES     NO

If so, how many and what ages are they?

Are you frequently visited by children?       YES     NO
If yes, do any of them have access to your yard/kennel/house when you are not at home? YES     NO
If yes, explain, please indicate how you intend to prevent them from teasing a dog, letting a dog out either intentionally, or by accident, or doing any other thing that might be detrimental to the welfare of a dog in your care.

Is anyone in your household allergic to animals?             YES      NO

Is anyone in your household afraid of dogs or cats?          YES     NO

Have you ever had a dog or cat before?                            YES     NO      
If yes, what happened to this dog or cat?
Do you have a dog or cat now?                                        YES     NO
If yes, how many dogs and cats do you currently own?
For each dog or cat you currently own, please answer the following questions:

What breed is it?
Is it a male or female?
How old is it?
What sort of temperament does it have, particularly with regard to other dogs/cats?
Is it spayed or neutered?                                                                                    YES    NO
Is it current on all its vaccinations and on heartworm preventative                           YES    NO
If behavior problems arose in your dog, how would you deal with them?

Are you familiar with the animal regulations in your area?                                       YES     NO

Do you know the requirements for obtaining a dog/cat license in your town?             YES    NO

Please list three people (name, address and telephone number) who are knowledgeable about you and your care of dogs and cats. Please include your vet as one of them, and two other people in the dog community (for example, a trainer, a groomer, a rescue person, or someone who has had dogs or cats all their life and knows you well). You may include a shelter or rescue person that you once adopted a dog or cat from. If you do not know a person in the dog community that can give you a reference, please list two people, who can give you a character reference, like an employer, a clergyman, or a teacher. List their names, email addresses or phone numbers, what is their relationship to dogs/cats, and what is their relationship to you. Without references we cannot complete your evaluation:

1.

2.

3.
 

3. PREFERENCES FOR A DOG OR CAT
Age:
Sex:
Would you consider an older dog/cat (4 years or older)?    YES     NO
Would you consider a cross?                                          YES     NO
Would you consider a dog/cat that has a physical problem, i.e., hip dysplasia, epilepsy, etc. that might be controlled or treated with the use of drugs, or surgery? YES    NO
Would you consider a dog/cat that has an emotional problem, i.e., separation anxiety, fear aggression, etc. that might be controlled or cured with training, behavior modification, or the use of drugs?                                               YES     NO
After researching a breed, are there any traits in a breed that you would prefer to avoid?           YES     NO
If yes, explain:

Would you consider more than one dog/cat?        YES     NO
Are you looking for a working/herding dog?           YES     NO    

Companion dog?                                                YES     NO

A dog for a formal sport or competition?                YES     NO

Is there a particular dog or cat on our website that currently interests you? If so, which one is it?
Are you in a hurry, or are you prepared to wait until the absolute best match can be made? ___I'm in a hurry. ___I'm willing to wait.

4. YOUR ENVIRONMENT
Do you live in an ___apartment, ___a condo, ___ a mobile home, ___a single-family house, ___on a farm, ___in military housing?
Do you ___own or ___rent your property?
If you rent, do you have permission from your landlord to have pets on the property? YES        NO
Are there any restrictions as to the number of dogs and /or combination of dogs and cats that you may have at your residence? YES     NO
Approximately how large is your property, i.e., square feet, acreage, etc.?

Do you have a fenced yard or outdoor kennel? YES          NO
What type of fence is it?
How large is the area it encloses?
How high is the fence?
Are you opposed to having someone come to your house to do a home visit?          YES     NO

5. YOUR LIFESTYLE WITH REGARD TO A DOG OR CAT
Are you willing to travel a distance to meet a dog or cat?                                       YES     NO
If so, how far?
Is there someone home during the day most days?            YES     NO
If not, how many hours will the dog or cat be alone most days?
Will the dog or cat live in the house with the family?           YES     NO
If not, where will it be kept during the day and at night?
When you go away during the day, where will the dog or cat be left?
If you go away for an extended period (overnight or longer), where will the dog/cat be left?
Will the dog/cat be allowed to run loose at any time?                                YES     NO       NA
Will you have your dog on a run, or trolley, or tied out at any time?             YES     NO       NA
If yes, please explain when and for how long:
Approximately how much are you willing to spend on vet care for a dog/cat each year?
What do you see as the normal vet care requirements of a dog/cat?

How do you intend to exercise this dog/cat?

Please add any information about yourself that you think would be useful in helping us select the right dog or cat for you.

I affirm to the truthfulness of my answers. I understand that any deception or fabrication of my answers will be grounds to disallow an adoption of a dog or cat from Charley's Strays, Inc. I understand that Charley's Strays, Inc. has the right to refuse any applicant. I also understand that if I do adopt a dog or cat from Charley's Strays, and for any reason I can not keep him or her, I am required  to return the animal to Charley's Strays.

Signed__________________________________________________   Date:__________________