Canine Castaways, Inc.

ADOPTION APPLICATION

NAME: *

ADDRESS: *

CITY, STATE, ZIP CODE: *

HOME PHONE: *

WORK PHONE:

YEARS AT CURRENT RESIDENCE: *

EMAIL ADDRESS: *

ALTERNATE EMAIL ADDRESS:

DOG OR DOGS YOU ARE INTERESTED IN: *

1. Do you presently own any pets? Yes No *

If YES, please list the name and kind for each pet.

2. Have you owned pets in the past? Yes No *

If YES, what kind and what happened to them?

3.a. If you own pets are they all spayed/neutered? Yes No

If NO, why not?

3.b. If you own dog(s) are they on heartworm preventative? Yes No

If NO, why not?

4. Where do you live? i.e. House, Apartment/Condo, Mobile Home, or Other: *

5. Does your home have a yard with a fence? Yes No *

Type of Fence:

Height:

How will the dog get exercise and relieve itself? *

6. Do you own or rent your home? Own Rent *

If you RENT, do you have permission from your landlord to keep a dog? Yes No

Please provide your landlord's name and telephone number. Enter N/A if you own. *

7.a. Do you have a crate to keep the dog in? Yes No *

7.b. Where will the dog sleep? *

7.c. Will the dog be allowed on furniture? Yes No *

8. What is the longest period of time that the dog would be left unattended? *

9. Does anyone in the household suffer from allergies or asthma? Yes No *

If YES, please describe:

10. Where will you keep the dog while you are at work or out on errands? *

11. Where will you keep the dog while you are on vacation? *

12. Why are you interested in this particular dog or breed?

13. If the dog you have listed is not available, do you have a preference for breed, sex, color or age? If so, what is it?

14. How many adults presently live in the home? *

How many are women and what are their ages? *

How many are men and what are their ages? *

15. Are there children presently living in your home? Yes No *

If YES, list ages:

16. Do you agree to a Canine Castaways representative visiting your home to inspect prior to and/or after adoption? Yes No *

17. Are you willing to enroll the dog in obedience class or other training if you experience behavior problems? Yes No *

18. Do you understand that the dog should never be allowed off lead in open places? Yes No *

19. Please provide us with a current veterinary reference (including phone number.) Please also contact your vet and give them permission to release information to us. *

20. Please provide us with a personal reference, not related to you. (including phone number) *

21. All of our dogs are spayed/neutered, vet-checked, up to date with shots and evaluated before they are placed. Our adoption donations, which range from $150 to $300, help with these expenses. Do you understand the need for these donations and the fact that all donations are NON-REFUNDABLE after 30 calendar days? Yes No *

22. Have you ever owned a rescued animal? Yes No *

23. Do you understand all of the expenses involved with caring for a dog, especially as it ages? Including but not limited to ordinary and emergency veterinary expenses, heartworm preventative, dental care, grooming, etc. Yes No *

24. Have you applied with another rescue organization in your search for your new family member? It helps us to realize this when trying to coordinate our volunteer efforts. I have an application currently submitted with another rescue
I applied with another rescue but did not adopt.
I have never applied with another rescue organization.
I adopted through another rescue organization in the past.
*

Please provide the name of any other group you have applied with.

25. Do you understand that there are no guarantees about the house training, behaviors, temperament or health of a dog that is adopted and that the adjustment period varies for each dog? Yes No *

26. How did you hear about us? *

27. Your additional comments: