Adoption Application - All Mixed Up Dog Rescue

Name of Dog applicant is interested in*:

Personal Information

Name*:

Physical Address*:

(No P.O. box numbers)

City*:

State*:

Zip Code*:

Cell Phone Number*:

Home Phone Number*:

Email*:

Name of Co-Applicant and relationship to you* (If applicable):

Please list the Name and Age of each adult living in your home (including yourself)*:

Number and age of children living in your home*:

Do you have any young children, such as grandchildren, who come to visit?
If so what are their ages:

If you have a roommate, please list them as a personal reference below:

Will your roommate be involved with caring for your dog, if so how:

Work Information

Your Occupation*:

How many days do you work in a week*:

How many hours per day*:

Co-App Occupation*:

Does the co-app work, if so how many days and hours per week*:

Description of Residence

Do you: OwnRent

Which of the following best describes your current residence? (Check one)
HomeApartmentMobile HomeDuplexTownhomeOther

How long have you lived at this residence*:

Landlord Name & Number, if not owned by you*:

Name & phone number for the Property Manager*:

Do you have an HOA in your community?
If so, please provide us with the manager’s name & number:

If you have a yard, is it fenced in:
YesNo

Height and type of fence you have on all sides*:

Do you have a dog door:
YesNo

Is dog door in the house or the garage:
N/AHouseGarage

Please Describe Your Typical Weekly Schedule

Is anyone home during the day:
YesNo

Who is that person:

If no one is home, how long will the dog be left alone*:

Arrangements for the dog while you are gone*:

Do you plan on leaving your dog outside when no one is at home:
YesNo

If so, for how long*:

If they will be outside, will shelter, shade and water be provided for them:
YesNo

Will you put your dog in a crate when you are gone:
YesNo

Have you ever crated a dog:
YesNo

Do you own a crate:
YesNo

Where will the dog sleep at night*:

Information About Your Lifestyle

Do you foresee any major life changes over the next two years?
(e.g., transfer at work, relationship change such as marriage, remodeling your home or yard, having children)*:

Have your children been around large dogs:
YesNo

How will you teach your children to handle a new pet*:

Will you supervise your children with your new dog:
YesNo

Have you been to a professional dog trainer before,
if so what organization were they with*:

Will you be going back to them again if necessary or look for a new trainer? List new trainer if applicable:

How will you obedience train your dog*:

If your dog does something you do not like, how will you correct them*:

Will you take your dog to dog parks or daycare to be socialized*:

Are you aware of the dangers public dog parks pose? What steps will you take to ensure your dog’s safety:

How will you make sure your dog gets enough exercise*:

What activities do you plan to do with your dog*:

Are you interested in specific training just for fun such as agility, sport games or nose work classes*:

Are you aware that a new pet may not like some of your family or friends*:

How will you introduce your new dog to them to get off on the right foot*:

Are you financially prepared to give your new dog any medical treatment he/she may need*:

Please list all animals currently in your home, please include their species, names, age, sex, are they spayed/neutered and how long have they been with you*:

Please list any pets in the past you have owned and why they are no longer with you*:

Have you ever had to re-home any of your pets, if so please provide the details*:

Your Vet Information

Current Vet Name*:

Vet Phone Number*:

Please list the name, species, sex and age of all pets treated there*:

Previous Vet Name*:

Phone number*:

Please list the name, species, sex and age of all pets treated there*:

If you do not have a vet please list the name and number of the vet you will be taking your new pet to*:

Personal Reference - Please do not list relatives, only friends, neighbors, roommates or co-workers

Name	Phone Number	Relationship

Finding You The Right Pet For Your Family

Why do you want this dog*:

What personality characteristics are you looking for in a dog*:

Please identify behaviors you would NOT be willing to work with*:

Adopted dogs experience an adjustment period of several weeks to several months. What do you expect that to involve*:

If this dog will be an addition to an existing dog(s), what steps would you take if the two (or more) dogs did not get along perfectly even though they did at the meet and greet*:

How will you deal with signs of aggression towards other dogs*:

If you have other pets, how will you help the dog learn to live as a pack member*:

The first few months upon adopting tend to be the most difficult. Your new dog has been through many transitions, and your home is just one more transition in his mind. Behaviors we hadn’t seen can crop up, or behaviors we saw can be amplified during the transition period. Working through these issues can be challenging and time consuming, please be as clear and honest as possible so we can help you adopt the best possible fit.

Are you willing to housetrain: YesNo

Are you willing to accept a dog with medical needs: YesNo

Are you willing to accept a dog that has been neglected or abused:YesNo

If the dog you are applying for is no longer available, or will not be a good fit for your family, are you open for our suggestion of another dog:
YesNo

How did you hear about All Mixed Up Dog Rescue?*:

When you submit this application you are acknowledging that the information given is true and accurate. A representative of All Mixed Up Dog Rescue will contact the references you provided. We understand that you are excited about adding a new member to your family but please understand that we are a volunteer organization and this process could take up to 14 days.

All Mixed Up Dog Rescue reserves the right to refuse adoption to anyone.