Adoption Application

We are committed to matching the right dog to the right family so all will have many happy years together. Our adoption process includes the completion of an application, phone interview, veterinary reference, home visit, adoption fee and contract. The standard adoption fee is $400 for dogs, $475 for puppies 5 months and younger. We reserve the right to refuse any applicant for any reason if we feel the needs of the dog will not be properly met or the adoption is not in the best interest of the dog. You must be 18 or older and living in New England to complete & submit the application.

Incomplete applications will not be considered. Please fill out all fields.

Your Name

Co-Applicant

Street Address

City, State, Zip

Home Phone

Work Phone

Cell Phone

Email Address (required)

A complete answer to the following questions will enable us to be more familiar with your request and requirements and will help us find the Rescue dog to match your needs and expectations.

GENERAL QUESTIONS

How did you hear about Great Dog Rescue NE?

Why do you want a rescue dog?

Who is the rescue dog primarily for?

INFORMATION ABOUT YOUR HOUSEHOLD

Please list all the members of your household with their ages & occupations:

Humans – Names, Ages & Occupations:

Current Dog(s) - Name, Age, Breed, Gender, Altered, Comfortable with dogs?

Current Cat(s) – Name, Age, Gender, Altered, Comfortable with dogs?

Current Other Pet Types - Type, Age, Comfortable with dogs?

Have you owned past dogs?  Yes No

If yes, what happened to the dog(s)?

If you do not have small children living in your home, will your Rescue Dog come into regular contact with any children under the age of 10?  Yes No

If yes, how often and what ages?

Does anyone in your house have allergies?  Yes No

If Yes, what kind of allergies?

Do you own or rent your home?  Own Rent

How long at current residence

If you rent, has your landlord provided written permission for you to have a dog?  Yes No

Please provide your landlord’s name & phone #

Do you have a fenced yard?  Yes No

If yes, please describe the fence (Type, Width, Length, Height)

If you don't have a fence, are you willing to install one?  Yes No

If no, please indicate why not?

Do you have a swimming pool?  Yes No

INFORMATION ON THE CARE OF YOUR DOG

Who will care for, train and exercise the Rescue dog?

How will you exercise your Rescue Dog?

Where will your Rescue Dog be kept during the day?

Where will your Rescue Dog be kept at night?

How many hours per day will your dog(s) be alone (without humans) on a regular basis – not including lunch breaks?

Will the dog(s) be allowed in the house?  Yes No

Will the dog(s) have the free run of the house?  Yes No

Will the dog(s) be kept out of certain areas in the house?  Yes No

Are you familiar with crate training?  Yes No

Are you willing to use a crate for your Rescue dog?  Yes No

Will the dog(s) be kept on a runner or tied outside?  Yes No

Will the dog(s) live in the yard?  Yes No

Will the dog(s) be walked daily?  Yes No

Will the dog(s) be exercised in a fenced yard?  Yes No

Will the dog(s) be allowed to run free outside of a fenced yard?  Yes No

It is strongly recommended that to build a bond with your new dog and establish the ground rules in your family that you enroll in a positive reward-based training class after your dog has settled into your home. Will your dog(s) receive formal obedience training?  Yes No

If yes, please identify the obedience trainer?

When you move, what will you do with your dog(s) (and/or other pets)?

Why do you think you would be a good adopter for rescue dog(s)?

REFERENCES

Who is your Veterinarian? [note: please contact your vet to preauthorize them to speak to our volunteer]

Vet’s phone number & address (required)

If you haven’t been with this vet for your pet’s entire life, please also provide us with your previous vet’s contact information.

Personal References – not a relative or household member

Reference #1 (name, phone & relationship)(required)

Reference #2 (name, phone & relationship)(required)

MISCELLANEOUS QUESTIONS

May we visit your home prior to application approval?  Yes No

If Yes, when?

Are you aware that dogs are active and shed all year long?  Yes No

Will you use a dog walker or doggy darecare to care for your dog? Yes No

Are you aware that routine costs of maintaining a dog can be at least $500 a year (for food, shots, checkups, heartworm & flea prevention, grooming, etc.)?
 Yes No

Have you sold, given away, or surrendered a pet to a shelter, pound or Humane Society?  Yes No

If yes, please provide details?

Do you understand the state and local ordinances concerning licensing?  Yes No

Do you understand the state and local ordinances concerning leashing?  Yes No

Have you or any member of your family/household been cited for leash law violations or animal cruelty?  Yes No

If yes, please provide details?

PREFERENCE QUESTIONS

Specific Great Dog you are applying for (please list just one):

Are you ready to adopt this dog immediately?  Yes No

Have you applied to other rescue organizations to adopt a dog?  Yes No

Are you comfortable with a long distance adoption if you can speak to the foster family?  Yes No

Would you consider a Special Needs Dog such as one who requires medication for a permanent but controllable condition?  Yes No

AGREEMENT

I/We attest that I/we understand that GDRNE makes no guarantees or statements regarding any dog's age, breed, health, or temperament. While GDRNE has made every effort to provide accurate history and assessment of all of the dogs, GDRNE is not able to guarantee any dog’s age, breed, medical status or history, behavior or disposition. I/We hereby release GDRNE and its employees, directors, members and representatives of any and all possible claims arising from injury or damage caused by any dog adopted by me/us to any person or property or relating to the health or temperament of the dog, including any expenses related thereto.

I/We attest that the Terms and Conditions of Adoption as stated in the Adoption Contract have been read in full by me/us and I/we understand that this is part of the adoption process and will be enforced. I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/We attest that we have retained a copy of the Adoption Contract and also understand that completion and submission of this application does not guarantee adoption of a Rescue dog. If filling out the application electronically, your name below substitutes for a signature.

Applicant’s signature (Name + last 4 digits of SSN) (required)

Today’s Date (required)

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