Dog Application form

How did you hear about Aide For Paws & Rescue Society?

Name of dog you are apply for

APPLICANT INFORMATION

Full Name *

First Name Last Name

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

Have you ever adopted an animal with another organization?

Yes No

If yes please list the name(s) of the groups you previously adopted from.

YOUR HOME

Do you live in a:

Do you:

Own Rent Live with Parents Other

How long have you lived at this residence?

If renting do you have permission from your landlord to adopt a new pet?

Yes No Unsure

Landlord's Name

Landlord's Contact Information

If living in a townhouse/apartment/ condo please provide a copy of your Strata bylaws. This is to ensure there are no breed or size restrictions as well as # of pets allowed per unit.

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Household Setting

Rural Suburban Urban

Describe your Homes Activity Level

Busy/Noisy Moderate Comings/Goings Quiet with Occasional Guests

Does your home have stairs?

Yes No

If yes how many flights?

Do you have a fully fenced yard?

Yes No

If yes how tall is your fence?

Do you agree to have an Aide For Paws member perform a home check visit?

Yes No

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/Cat?

Yes No

If your current relationship changes, with whom will your dog remain?

Do you have someone who can care for your dog in the event of serious illness/death?

Yes No

Who in your household will be responsible for caring for this dog?

Myself My spouse/partner My children

When traveling/away from home, what arrangements will be made for the care of your dog?

How much time per day are you planning on exercising your dog?

Less than 30 minutes 30-60 minutes 1-2 hours 3+ hours

How do you plan on exercising your dog?

Leashed Walks Backyard Dog Park

On average how many hours per day will your dog be left home alone?

Where will your dog be kept when left alone?

Loose indoors In a crate Dog house outdoors In the garage

YOUR PETS

Have you ever owned a pet before?

Yes No

Current Pet #1 (please list type of animal, breed, age, sex, and if they are spayed/neutered

Current Pet #2 (please list type of animal, breed, age, sex, and if they are spayed/neutered

Current Pet #3 (please list type of animal, breed, age, sex, and if they are spayed/neutered

Other pets not listed above

Have you ever surrendered or given away a pet before?

Yes - surrendered Yes - given away No

If yes please describe the circumstances.

PET CARE/COMMITMENT

Are you adopting this dog for yourself or someone else? (Please specify)

Myself My spouse My children

Why are you adopting a dog (check all that apply)

Companion Protection Teach child responsibility Companion for existing dog Working dog (please explain)

If Working Dog and/other was selected above please explain

For what reason would you return/re-home your dog? (Check all that apply)

Allergies Moving Separation/Divorce New Baby Behavioral Issues Medical Issues Not getting along with other pets Not enough time

How much do you think it costs to feed one dog for one month? (keep in mind that some dogs may require a specialized diet)

What kind of behaviors would you NOT tolerate from your new dog?

Digging Chewing Barking Not house trained

What are your plans for training this dog? (check all that apply)

I am dog experienced and don't require help Basic obedience classes Private sessions with trainer

Are you willing to consult a trainer for behavioral issues?

Yes No

If yes, how much as you willing to spend on training?

$50 $100 $200 Whatever it takes

Have you ever previously owned a dog?

Yes No

If yes above do you still own the dog(s)?

Yes No

If you answered no above please explain

Are you prepared to make the 10-15+ year commitment a dog requires?

Yes No

MEDICAL CARE

Do you currently have a veterinarian?

Yes No

If yes please list the veterinarian's name, clinic name and address as well as the name your pet is registered under at this practice.

Have you ever used other veterinary services in the past 10 years?

Yes No

If Yes please list the clinic name, address, and the name of the pet(s) seen. If you have visited more than 1 clinic please list the above information for all clinics your pet(s) have been seen at.

If you do not currently have a veterinarian what is the name of the veterinary clinic you intend to use?

Are you comfortable giving medication if you pet becomes ill? (pills, eye drops, injections, etc)

Yes No

How much will you budget for basic veterinary care per year (annual examinations, vaccines if necessary, accidents/emergencies, etc)

In the event of a serious illness or accident will you be able to afford medical expenses?

Yes No

Have you considered signing up for pet insurance?

Yes No Unsure

If no please explain.

Under what circumstances would you consider euthanizing your pet?

Our adoption agreement states for any reason if you are no longer able to care for the dog(s) the dog(s) must be returned to Aide For Paws. Do you agree with this?

Yes No

Do you have any further comments and/or questions?

REFERENCES

Do you give permission for an Aide For Paws representative to contact your veterinarian(s) to vouch for you as a responsible pet owner?

Yes No

Vet Reference: Full 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

Do you give an Aide For Paws representative permission to contact references to vouch for you as a responsible pet owner?

Yes No

Please provide references who know you as a pet owner and can vouch for your overall responsibility (someone who has known you for at least 3 years)

Personal 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

Personal 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

Personal 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

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I have completed this application form honestly and to the best of my ability. I understand that the omission of information and/or failure to answer all questions can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Aide For Paws & Rescue Society (A4P) reserves the right to annul the adoption and reclaim the animal.

I certify that the above information is correct, and I understand that the information will be verified.

I agree to have Aide For Paws & Rescue Society complete reference call checks to my veterinarian(s), landlord & personal references, if applicable. I also agree to a home check visit on a mutually agreed date by an A4P representative before an adoption decision is made.

I understand the adoption decision is dependant on many factors, including compatibility of the family, home and lifestyle to the individual animal. I understand that the members of A4P decide which home is most appropriate for the animal and their their decision if final, therefore, I will not argue with the decision made.

Date

Month Day Year

Your name *

E-mail