Pet Orphans Adoption Application

SmallDog Rescue Adoption Application

SECTION I—ABOUT YOU

SECTION II - CURRENT AND PRIOR PET HISTORY

SECTION III—ABOUT YOU AND YOUR NEW DOG

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PLEASE READ: Our adoption process begins with a completed application submitted by you. If you are approved to adopt a dog from SmallDog Rescue, an adoption fee of $275 is required. Some situations (including, but not limited to, military deployment, senior citizenship, major medical considerations and employment that may require overseas transfer) may require a Co-Applicant. Applicants must be at least 21 years old. SDR does NOT adopt outside the Metro Atlanta area. It may be several days before you receive a response from SDR regarding your application. A screener will contact you via e-mail, so please make sure your e-mail address is accurate and legible, and be sure to check your e-mail for a reply from SDR.

PLEASE NOTE: You must complete all applicable sections in detail to avoid a delay in the screening process!

If you would like to print out an application and mail it, please click here.

Address
City	County	State	Zip
Subdivision

Home Phone

Work Phone

Cell Phone

Email (required)
Who is the primary dog you are interested in?
Please list other dogs, breeds or breed types you might be interested in:

Are you willing to allow a representative from SDR to visit your home by appointment?

Yes

Why do you want to adopt this dog?
What questions do you have about this dog?

Please indicate where you live: apartment house condo/townhouse trailer/mobilehome

Do you: rent? own?

If you rent, do you have the landlord's permission to own a dog? Yes No
What is the apartment complex name?
What is the landlord's phone number?
How much is the pet deposit? $
How many times have you moved in the past 5 years? times
If you were to move, what would you do with your pet?
Do you have a fully fenced yard with no fence gaps? Yes No
If Yes, please describe, in detail, your yard and the fence surrounding it. (i.e. height, privacy, shadowbox, chain link, split rail, invisible, balcony, etc.):
If no, would you consider fencing all or part of it as a condition of adopting a dog? Yes No
How do you plan to exercise your dog?
Do you have a doggie door? Yes No
If Yes, how do you use it?
Do you have a pool,lake, pond or any other body of water on your property? Yes No
If Yes, what measures will you take to protect your dog around bodies of water?
Number of adults in household?
Relationship(s): spouse roommate(s) life partner other - please specify:
Does anyone in the household smoke? Yes No
If yes, please elaborate:
Do any family members have allergies? Yes No
If yes, please elaborate:
Will this dog be a surprise for any family members? Yes No
If yes, for whom?
Do any children live in the house or visit frequently? Yes No
If Yes, how many and what are their genders/ages?
Are your children accustomed to being around dogs? Yes No
If Yes, please explain?
Who will be primary caretaker for this dog?
Please describe any major changes you foresee in your life over the next 15 years (average lifespan of a dog), such as marriage, childbirth, health problems due to age, going away to college:
If yes, please explain:
Do you or anyone in your household currently have any serious health problems? Yes No
If yes, please describe:

Please tell us about all of your current pets. Include name, species, breed/breed type, weight, male/female, age, years with family, temperament with dogs/people, and where he spends most of his time. It is important that you include ALL of this information.

Were they spayed/neutered? Yes No

Please list all pets you have had in the past as an adult (pets you no longer have in your household). Include name, species, breed/breed type, weight, name, male/female, age, from what date to what date you had this pet, and why this pet is no longer with you (ex. put to sleep, run over, died of old age, sold, given away, ran away). It is important that you include ALL of this information.

Are they spayed/neutered? Yes No

Do any of your current pets or did any of your past pets you owned as an adult live primarily outdoors? Yes No

If Yes, please describe the pet and circumstances:

Please provide information about your veterinarian(s) over the past 5 years. Include name of animal hospital/clinic, city/state, phone number, whose name is pet listed under. It is important that you include ALL of this information:

Please tell us what you know about heartworm disease and how to prevent it?

Is your current dog or was your previous dog on heartworm preventative? Yes No

If yes, how often do/did you give the heartworm medication?

What brand do/did you use?

How do you plan to prevent fleas and ticks?

How aware are you of the many costs involved in caring for a new dog (medical expenses, nutritious foods and accessories) and your ability to financially support him/her? Please elaborate:

How many hours will the dog be home alone on a typical day?

Please describe where your current/previous pet(s) stays/stayed when home alone during the day (ex. outside in fenced yard/dog pen, outside on tie-out, inside in basement, garage, free run of house, inside in one room of house, inside in crate, etc.):

Please describe where you expect your new dog to stay when home alone during the day (ex. outside in fenced yard/dog pen, outside on tie-out, inside in basement, garage, free run of house, inside in one room of house, inside in crate, etc.):

Please describe where you have/had your current/previous pet(s) sleep at night (ex. dog house in fenced area/dog pen, dog house near tie-out, inside in basement, in the garage, inside free run of house, inside in one room of house, inside in crate, in your bed, etc.):

Please describe where you expect your new dog to sleep at night (ex. dog house in fenced area/dog pen, dog house near tie-out, inside in basement, in the garage, inside free run of house, inside in one room of house, inside in crate, in your bed, etc.):

On a typical day, how much time do you expect your new dog to spend inside the house?

Have you ever had a behavior problem with a current or previous dog Yes No

If Yes, please describe the behavior and the measures you took to resolve it:

Please describe your plans for training your new dog (ex. Private instruction, group classes, do it yourself, etc.):

If your dog did something you didn’t like, how would you teach him not to do it again (ex. pop on the nose, positive reinforcement, a firm voice correction, a combination, etc.)?

What method will you use for housetraining?

Have you always kept an ID tag (other than a rabies tag) bearing your phone number on your pets?
Yes No

Are you willing to keep a collar and ID tag on all of your pets, including a new dog, at all times?
Yes No

Have you ever given a dog up or had a dog for a brief period of time and it didn't work?
Yes No

If yes, please explain the circumstances and what happened to it:

First Name

Occupation

Co-applicant (Spouse or Significant Other)

First Name

Occupation

Under what circumstances do you think it is okay to leave a dog outside, alone and unsupervised, in an UNfenced area? Please explain in detail

Under what circumstances do you think it is ok to leave a dog off-leash with supervision in an UNfenced area? Please explain in detail

What circumstances warrant giving up your dog?
moving new baby not getting along with other pets divorce getting out of fence behavioral problems children lost interest if it gets too big too time consuming shedding allergies housebreaking problems owner's medical problems pet's medical problems aggressive behavior getting on the furniture other reasons : please explain:

Have you previously applied for a dog with either this rescue group or another rescue group?
Yes No

If so, how long ago?

Did you adopt? Yes No Please explain:

Our contract requires that, if you are unable to keep your dog for any reason at any time, you must return the dog to SmallDog Rescue. Are you comfortable that you can abide by that provision?? Yes No

If no, please explain:

If you date or marry someone who does not like or want your pets, what would you do?

Suppose your pet develops a medical problem that becomes expensive (ex. $750 surgery for kidney stones or $25 monthly for eye ointment) but he/she can still enjoy a good quality of life. What would you do?

If your pet develops incontinence as he/she ages and can no longer “hold it” when left alone, what would you do (ex. have dog put to sleep, babygate dog in a specific area, put in a doggie door, give him up to a shelter, use a bellyband or diaper, etc.)? Please explain in detail:

If you are considering a long-haired breed, how often would the dog be groomed?

Would he get haircuts? Yes No

Would you do it yourself? Yes No

Have a groomer do it? Yes No

What type of food to you plan to feed your new dog?
something from the grocery store
premium food from a pet supply store
food from a veterinarian
Brand name you have in mind or brand you feed your current pet:

Has a dog or puppy died on your premises in the last 6 monthsof distemper, parvo or other causes? Yes No

If yes, please explain:

Please list the names, addresses and phone numbers of 2 personal references (no relatives or significant others, please):
Reference 1.

Reference 2.

How did you hear about SmallDog Rescue?
website newspaper word of mouth radio at an adoption day other - please specify:

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of the rescue dog and/or possible removal of said dog from my home.

Signed: Date