Please complete the on-line adoption form below and submit. You will receive a copy of the application if it submits successfully. Please enable JavaScript in your browser to complete this form.Name of dog you are applying for: *The name of who you would like to adopt goes here. You can put "any dog" or "undecided" if you are filling an application in advance of dog selection.Second choice if applicableDesired time frame for adoption (one week, one month, etc)Are you considering any other dogs presently?Full name of adult(s) in the home *Occupation(s)Full Physical Address Where You ResideBest Phone Number(s) to Reach You and Best Time to CallEmail Address(s) *How many adults are there in your family and their relationship to you?Number of children and ages?What type of home do you live in?Single FamilyTown HomeApartment / CondoFarmOtherHow long at this address?Own or Rent?If you rent, please describe rules governing pets and the landlord contact name/number. Please describe your household mood, activity, level, etc:Does anyone in the family have a known allergy to dogs/cats?Is everyone in agreement with the decision to adopt a dog?Do you have time to provide adequate love and attention?Do you have a fenced backyard? Is the fence sturdy and reliable?What other pets do you currently have? (describe type, number, and age please)Are these pets up to date on vaccines and spayed/neutered?If you do not have current pets, have you owned a dog before? Please elaborate when in your life, type, etc.Have you ever surrendered a pet? if so, why?Have you ever had a pet euthanized? If so, why?Have you ever lost a pet to an accident?Please indicate which of these are valid reasons to rehome / return a dogChewingDestructiveBarkingAggressive with humansAggressive with other dogsDiggingEscaping the yardBitingGoing potty in the houseOwner is movingHave you ever had to seek out training for an animal? How did that go?Are you willing to invest in training, doggy daycare, and a dog walker if ever necessary?If you are applying for a puppy, have you ever survived puppyhood before?Please describe what drew you to this particular dog out of all the listings on Petfinder / RescueMe, and why you want this dog,What is your idea of an ideal dog with respect to personality?Desired Age and SexDesired SizeDesired Breed(s)Breeds you would not adopt, and why?Are you willing to adopt an animal that may need training, medication, or grooming or some point?Where the dog will spend the day? (describe)Where will the dog sleep? (describe)Number of hours (ave) dog will spend alone and where?Who will have primary responsibility for this dog's daily care?Who will have financial responsibility for this dog?Do you agree to provide regular health care by a licensed veterinarian? *YesNoDo you agree to keep the dog as an indoor pet? *YesNoDo you agree to contact Poi Dog Rescue if you can no longer keep this dog? *YesNoVeterinarian Clinic NameVeterinarian Clinic Phone Number (by providing this number you are authorizing Poi Dog Rescue to contact your vet)Personal Reference #1 (Name, phone number)Relationship of Reference #1 (relative, neighbor, friend, etc)Personal Reference #2 (Name, phone number)Relationship of Reference #2 (relative, neighbor, friend, etc)NameSubmit
