CONTACT INFORMATION

~FILLING OUT THIS FORM DOES NOT CONSTITUTE AN ADOPTION AGREEMENT~

~ALL CANDIDATES WILL BE CONSIDERED WHEN MAKING A FINAL DECISION~

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Is there a dog on our site that you're interested in? *

None in particular

Yes, and their name is: Yes, and their name is:

FAMILY & HOUSING

What type of home do you live in? (House, Townhouse, Condo, Apartment, Farm, Mobile Home, Other?) *

How long have you lived here? *

If you rent, please give the rules governing pets and the landlord's name and number: (By providing this information, you're allowing Blackdogs Rescue to contact the landlord. Please inform them so they will speak with us.)

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How many adults are in your family: (their relationship to you?) *

How many children - and ages? *

Please describe your household: *

Active

Noisy

Quiet

Average

Does anyone in the household have a known allergy to dogs? *

Yes

No

How did you hear about Blackdogs Rescue? *

Would you be interested in fostering? *

Yes

No

Would like to know more

ABOUT THE DOG YOU WISH TO ADOPT

Is everyone in agreement with the decision to adopt? *

Yes

No

Expenses for regular vet visits, treatments, vaccines and emergencies can cost from $300 to $500 annually or more.

Is your family willing and able to accept the expenses of caring for a pet? *

Yes

No

Please check ALL reasons you're interested in adopting this animal: *

What is your idea of an ideal dog for your family?

Desired age:

Desired size:

Desired sex: *

Spayed Female

Neutered Male

No Preference

Desired breed:

Breed you would not adopt?

Obviously, there is no guarantee as to the breed of the dog and it is based on our best guess and given information.

Willing to adopt: *

Number of hours (average) the dog will spend alone? *

This dog will be mostly: *

Indoors

Outdoors

Are you willing to let a representative of Blackdogs Rescue visit your home by appointment? *

Yes

No

Where will the dog spend the day? (describe) *

Where will the dog spend the night? (describe) *

When the dog will be outside, how do you plan to supervise it? Will it be in a fenced yard- what size? *

Who will have primary responsibility for this dog's daily care? *

Who will accept financial responsibility for this dog? *

Do you agree to provide adequate love, attention and medical care for this dog? *

Yes

No

If you cannot keep this dog for any reason, do you agree to contact Blackdogs Rescue and surrender the dog? *

Yes

No

OTHER PETS

What other types of pets do you have: (specify number, types, and ages) *

Are these pets spayed/neutered? If not, why? *

Are these pets up to date on vaccines? *

Yes

No

How do you discipline your pets, and why? *

Have you ever surrendered a pet? If so, why? *

Have you ever had a pet euthanized? If so, why? *

Have you lost a pet to an accident, and how? *

VETERINARIAN

Do you have a regular veterinarian? *

Yes

No

Trying to find one

Veterinarian's Name *

Clinic Name *

Clinic's Address *

Clinic's Phone Number *

(By providing Blackdogs Rescue with this information you are allowing Blackdogs to contact your vet. Please notify your vet and ask them to authorize the release of information to Blackdogs Rescue)

Do you use flea/tick treatment? *

Yes

No

Do you use heartworm treatment? *

Yes

No

Do you understand and accept that while we believe all adoptable animals to be in good health, we do not guarantee it and that medical care, at your expense, may be necessary? *

Yes

No

Initial Initial

Do you understand that a representative of Blackdogs Rescue may make an inquiry of any animal at any time, and may visit your home for follow up information? *

Yes

No

PERSONAL REFERENCES

Please list someone who is familiar with both you and your pets

Name *

Relationship *

Address *

Phone *

I am capable of handling, interacting with, and providing responsible care and treatment for the pet I propose to adopt, and I am prepared to demonstrate this to the satisfaction of a Blackdogs Rescue representative. *

Yes

No

I understand that completing this application is not a guarantee that I will be allowed to adopt a pet and that Blackdogs Rescue has the right and responsibility to deny any adoption. *

Yes

No

I acknowledge all of the information on this application is correct and complete.
I hereby give my permission to Blackdogs Rescue for verification as a requirement of their review process. *

Yes

No

Applicant Signature *

Date *

Drivers License Number *

State *

Family Pet	Companion
Gift	Guard Dog
Breeding	Agility or Obedience
Companion for Other Pet	Registered Service Animal
Other Other

outgoing / hyper dog	shy dog
dog that needs training	dog that needs regular grooming
dog that needs regular medication	dog with medical / special needs
none of these