First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

What animal are you interested in adopting?*
Choose an animal: Alvin (must be adopted with Simon and Simon) Archie Bessie Billie Blondie Blossom Brody Brooke Brownie Bruce Chase Cinnamon Duke Ezra Flick Gus Indy Iris Jack Kobe Leo Levi Liam Louise Lucky Mara Minnie Driver Murphy Simon (must be adopted with Alvin and Alvin) Skye Sophie Spice Squeaks Sugar Sunny Thelma Wynnona Ziggy Zion

Please enter your birthdate.*

If something were to happen to you, who would take care of your pet(s)?*

How long have you lived at your current address?*

Are you applying for a number of different dogs from different rescues or just this dog?*
Choose one: Just this dog Applying for a number of dogs

How many members are in your household, including yourself? What are the ages of each member of the household, including frequent visitors?*

Do you currently own other pets? If so, please list their info (type of animal, age).*

Will this dog be a companion dog, guard dog, children's dog, other. Please be prepared to explain "other".*
Choose one: Companion dog Guard dog Children's dog Other

If you own pets, are they spayed/neutered?

What is your occupation?*

How many estimated hours will the dog(s) be left alone due to work/other commitments on an average day?*

Do you live in a house, condo, apartment, or other?*
Choose one: House Condo Apartment Other (please be prepared to explain)

Do you own or rent?*
Choose one: Own Rent

If you do rent, what is your landlord's policy on pets? If you do not rent, please state N/A.*

Where will your dog sleep at night? Be specific.*

Is your property surrounded by fencing, block wall, etc.? (Describe material, height)*

Do you have a pool or a pond on your property that is accessible to pets?*
Choose one: Yes No

If yes, is it surrounded by a fence or other barrier?*
Choose one: Yes No Not applicable

If pool or pond have no fencing, how will you ensure their safety? If no pool, please enter N/A.*

Do you have a doggy door? If so, is it always open, open when you're home, closed at night, etc.?*

Do you have any objections to an in-person home check? We check the yards for safety as well as where the dog will be spending his/her time.*
Choose one: Yes No

Does anyone in your home have allergies? What would you do if someone developed allergies?*

What energy level are you looking for in your pet?
Choose all that apply: Mellow High Energy Average Energy

Where will your pet spend most of his/her day? Please be specific.*

May we contact your current vet as a reference?*
Choose one: Yes No Not applicable

Please provide your vet's information if we may contact them as a reference. If no vet, please enter N/A.*

Rescues are provided basic medical exams. Pet's can have medical issues that we are unaware of. Medical needs can be discovered at any time after adoption. Are you financially prepared and able to take your pet to the vet and cover the cost of any necessary treatments throughout your pet's lifetime?*
Choose one: Yes No

Have you ever surrendered a dog to a shelter?*
Choose one: Yes No

Have there ever been any circumstances under which you've relinquished a pet?*
Choose one: Yes No

Some rescue pups are not fully potty trained and even potty trained dogs may have accidents as they acclimate to new surroundings. Are you willing to work with your dog on potty training?*
Choose one: Yes No

What will you do if your new dog ruins clothes, shoes, furniture, toys, etc?*

Under what circumstances would you return a dog to the rescue?*

Would you attend training for any bad behavior prior to returning your dog to the rescue?*
Choose one: Yes No

If you moved would you take your dog with you?*
Choose one: Yes No Maybe

Do you have any questions/comments for us?*

By typing your name below you acknowledge and agree to the following: I understand that there are inherent risks involved with interactions between humans and dogs, as well as between dogs and other dogs, which may result in property damage or bodily injury, including but not limited to permanent disability, sickness or death to human or dog, and there may be other risks which I will assume if not known to me or any Our Underdog Rescue Squad representative, nor readily foreseeable at this time (collectively "risks"). "Sickness" includes any illness not limited to bordetella (kennel cough), canine influenza, bloat, or any other form of contagious disease. I fully accept and assume all risks and responsibility for all risks, including without limitation, all losses, costs and damages incurred as a result of my, a friend or family's, and/or my dog(s) participation in a meeting, adopting, fostering, volunteering for an Our Underdog Rescue Squad dog, including any veterinarian expenses. In the event of any litigation, I agree to pay the cost of all legal fees for all releases. I acknowledge that I have read, understand, and can read this statement and understand the English language. This agreement and release of liability will last in perpetuity.*