1. Name of Applicant:*
2. Age of Applicant:*
3. Name of Co-Applicant:
4. Age of Co-Applicant:
5. Address of Applicant:*
6. Phone Number:*
7. Email Address:*
8. Applicant's Employer, Position, Phone:*
9. Co-Applicant's Employer, Position, Phone:
10. Type or name of dog you are interested in:*
11. Veterinarian's Name & Phone:*
12. Number of children in your home:*
None
1
2
3
4
5
6
7
8
13. Children's age(s)
14. Do they live with you full time?
15. Number of adults in your home:*
1
2
3
4
5
6
7
8
16. Is anybody home during the day?* Who?*
17. Who will be responsible for caring for the dog?*
18. Do you consider the location of your home to be:*
19. Type of home:*
20. Do you own or rent?*
21. If you rent, you MUST provide proof that you are allowed to have dogs.
Landlord's Name & Phone Number:
22. How would you describe the activity level in your home?*
23. Do you have a fenced-in yard?*
24. If yes, what type & height of fence do you have?
25. If fenced, how many gates do you have & how are they secured?
26. Why are you interested in adopting a dog?*
27. Many rescue dogs have been neglected and discarded and may have behavioral/emotional issues. How are you and your
family prepared to deal with these potential issues?*
28. Will the animal be kept:*
29. How long will the animal be left alone during the day?*
30. Do you have any of the following?
31. When the animal is home alone, will it be:*
32. How much do you think taking proper care of a dog will cost in one year’s time (including food, vet care, grooming, licensing & any other expenses):*
33. Do you believe in spaying/neutering?*
34. Are your current animals spayed/neutered?*
35. If no, why?
36. This dog could depend on you for the next 14 years. Are you prepared to make that commitment?*
37. Have you ever given up a dog before?*
38. If yes, for what reason?
39. For what types of behavior problems would you return a dog:
40. If "Other", please describe.
41. To help resolve the problems, are you willing to crate train?*
42. To help resolve the problems, are you willing to attend obedience class?*
43. What will you do with the dog when you are on vacation?*
44. What will you do with the dog if you move?*
45. Under what possible circumstances would you return the dog?
46. If "Other", please describe.
47. Please list animals that you have previously owned, if any (other than fish, rodents & reptiles), describing what happened to them:*
48. Please list all animals that you presently own, if any (other than fish, rodents & reptiles). Please include animal/breed, age, gender,
time owned, neutered/spayed, vaccinated, on heartworm preventative?*
49. Provide the names & phone numbers of two references (i.e. co-worker, acquaintance, neighbor. NO family members)*
50. Individuals who adopt from K-9 New Life are contacted periodically for an update to help ensure that the animal successfully
adjusts to its new home. If you adopt a dog from K-9 New Life, will you consent to occasional contact to ensure the dog is
doing well in your home?*
If at any time an adopter cannot keep the animal, it MUST be returned to K-9 New Life!
By electronically signing to the right, I acknowledge that I have read this questionnaire completely, comprehend it fully, know that applying
does not ensure approval, and that untruthful answers or failure to comply with the requirements of this application or the
adoption contract can result in the forfeiture of any K-9 New Life dog adopted by me.*
K-9 New Life reserves the right to refuse or deny any application for any reason other than race, creed, color, or religion.