Freedom Dog Rescue Adoption Application

You can also upload your completed adoption application which is posted on our website at www.freedomdogrescue.ca

Where did you see this adoptable?

Dog of Interest

Full Name *

First Name Last Name

Occupation

Age

Spouse Full Name

First Name Last Name

Spouse Occupation

Spouse Age

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number - Home

Area Code Phone Number

Phone Number - Cellular

Area Code Phone Number

Phone Number - Work

Area Code Phone Number

Do you live in a: *

Do you:

Own Rent Live with Parents Other

If Renting: Please indicate landlord contact information

Household Setting

Rural Suburban Urban

Describe your Homes Activity Level

Busy/Noisy Moderate Comings/Goings Quiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)

Does Anyone in your Household have Allergies to Animals?

Yes No

Are all members of your family agreeable to adopting a dog?

Yes No

Please list any pets you have living or deceased (Please include name, breed, age, spayed/neutered, sex, vaccinations up to date, heartworm, living/deceased)

Why do you want to adopt a dog?

Have you ever owned the breed of dog that you are applying for? If so, where, when and from whom was it acquired?:

Veterinarian Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Veterinarian used in the past?

First Name Last Name

HAVE YOU GIVEN PERMISSION TO YOUR VETERINARY CLINIC TO RELEASE INFORMATION ON YOUR FILE? This step does cause to slow down adoption process if we have to contact to ask to do this. If there are 2 applications on same dog, the vet records can play a big part in final adoption. *

YES NO

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Do you have a preference of male or female?

Male Female No Preference

Are you willing to adopt a dog of any age?

Yes No

If not, what age would you consider?

What size dog are you looking for? (Check all that apply)

Small Medium Large

Please describe the type of dog you are looking for if not applying for a specific dog in care. (Please include breed, approximate age, coat length, personality traits, energy level, hypoallergenic)

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

Yes No

Have you had any experience with with an emotionally or physically neglected or abused dog?

Yes No

If Yes please explain

Are you willing to use a crate for a dog if recommended?

Yes No

Do you have a fenced yard? *

Yes No Partial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day would the dog be left alone? *

What are you plans to exercise your dog? Please list any parks nearby or trails, how many walks a day, approximate length, activities such as agility

Who will have primary responsibility for the care of the dog?

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

Yes No

Reference #1: Full Name

First Name Last Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Reference #2: Full Name

First Name Last Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Reference #3: Full Name

First Name Last Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Are you willing to have a member of Freedom Dog Rescue visit with you, by appointment, prior to and after any adoption?

Yes No

If no transportation can be found, will you be willing to travel to collect a dog?

Yes No

We require an adoption fee to defray veterinary and other expenses. Are you willing to do so?

Yes No

Comments:

IF ACCEPTED AS AN ADOPTER:BY SUBMITTING THIS FORM, I ACCEPT IT AS A BINDING CONTRACT AND UNDERSTAND AND AGREE TO THE FOLLOWING.Any dog adopted from Freedom Dog Rescue is to be an indoor dog and treated as a member of your family.Any dog adopted from Freedom Dog Rescue shall be afforded all necessary vaccinations, licenses, heart worm and flea prevention, plus any medical treatment that may become necessary.If for any reason, you can no longer care for your adopted dog, it must be returned to Freedom Dog Rescue. Freedom Dog Rescue retains the right to remove a dog adopted from us that has been deemed abused, neglected, or found to be in a situation that may not be in the best interest of the dog.I hereby give permission for my Veterinarian to release information to Freedom Dog Rescue on any pets that I have owned, live or deceased. Freedom Dog Rescue reserves the right to refuse a dog to any applicant. Any misrepresentation of fact may result in my not being approved to adopt a dog from Freedom Dog Rescue. All information I have given on this form is true and correct.

Date

Month Day Year

Your name *

Co-Applicant name (if applicable)