Rescuing Animals In Need Dog and Puppy Online Adoption Application

I wish to adopt(animal's name): If you don't want a specific animal use dog, or puppy

Type of animal: Dog Puppy

Foster's name (leave blank if you don't know):

Please provide the following contact information:
You MUST provide an EMAIL.

Emergency contact name and phone:

rent or own?

If renting, Landlord name and phone:

If renting, is pet deposit paid? -- No Yes

Are there rental/lease/homeowner association breed or weight restrictions? -- No Yes I don't know

Do you have a fenced yard? -- No Yes

How many adults in household?

How many children?

If children, please list ages

Has everyone agreed to take responsibility for this animal? --- Yes No

Is anyone allergic? If yes, how will you handle this (include answer in comments section) --- Yes No

Is this an impulse adoption? -- Yes No

Is this adoption a gift? -- Yes No

Please list number and types of current pets:

Are all pets spayed/neutered? -- Yes No

Are all pets current with vaccines? -- No Yes

Are all current dogs on year round heart worm preventative? -- No Yes

If so, what kind

Have you had this type of pet before? -- Yes No

If yes, what happened or do you still have them?

If you have dogs currently where do they live? -- Inside Outside Screened Porch Inside and outside Inside and screened porch Inside, outside and screen't porch

Where will this dog live? -- Inside Outside Inside and outside Screened Porch Inside and screened porch Inside, outside and screened porch

How will this dog spend its time home alone? Check all that apply

    Indoors, no restrictions

    Indoors, crated/kenneled

    Indoors, room restricted

    Outdoors, no restrictions

    Outdoors, yard/kennel

    Outdoors, chained

How many hours/day on average will the dog be home alone?

How do you intend to exercise this dog?

How long do you intend to keep this animal?

If you move will you take this animal? -- Yes No Maybe, if apartment allows pets

Most shelter animals have unknown medical backgrounds. Once you take possession of this animal are you prepared to take it to a licensed veterinarian for regular check-ups and any other necessary medical treatment at your expense?
-- Yes No

Who is/will be your veterinarian?

Are you prepared for the costs of a pet, including food, litter, yearly check-ups, grooming, etc?
-- Yes No

Are you aware that this animal requires a lifetime commitment and may live 15+ years?
-- Yes No

R.A.I.N.'s adoption policy states that if the adoption doesn't work out for some reason you agree to return the animal to us. Will you comply?
-- Yes No

R.A.I.N.'s funds are very tight due to medical and other costs. Therefore, we have a "no refund" policy. Is this acceptable?
-- Yes No

Do you agree to participate in follow-up calls or visits from R.A.I.N. volunteers?
-- Yes No

Additional Comments:

I hereby confirm that the information supplied here is truthful. I understand that Rescuing Animals In Need, Inc. (RAIN) may refuse adoption for any reason or may confiscate an animal at any time, if the information given here is deemed incorrect or if the animal is not being cared for properly. I further understand that if I cannot keep this animal for any reason, I will contact Rescuing Animals In Need and make arrangements to return the animal, so that RAIN places the animal in another suitable home. Please fill in your name:

(RAIN use only) Approved /Denied (and reason)