Companion Animal Rescue

NOTE: Due to the difficulty of performing a home visit, we do not do not place dogs north of Port St. Lucie or west of Fort Meyers

Dog/Puppy Adoption Application

Please answer all questions completely. We are not trying to be intrusive.  We are volunteers doing everything we possibly can to find the best match for each dog and each family.  Thank you for understanding.

YOU MUST BE OVER 21 YEARS OF AGE TO ADOPT.

Date  Name of dog/puppy 

NameHome phone#Cell#
AddressApt#
City/State/Zip
Email 
Please enter an email.Otherwise your application may be accidentally filtered.

Age Occupation
Employer Phone# 
Years employed there
Marital Status Partners Name

1) What type of home do you live in: (reply "yes" to the most applicable answer). 
Single Family
Townhouse
Mobile Home
Condo
Apt.
Boat

2) Years at current address?

3) If you rent is your lease :(reply "yes" to the most applicable answer)
 Yearly
Monthly
Weekly.

4) If renting, are there any pet restrictions?

5) If yes, what are they?

6) Do you have a fenced in yard?

7) If yes, what type of fence?

8) If no, are you willing to put one in?

9) What is the name of your landlord?
Phone#

10) Do you plan to move in the near future?

11) Are there children in the home? How many Ages

12) Have you ever given an animal to an animal shelter before?

If yes, Explain

13) Are you prepared to make a lifetime commitment to this dog?

14) Are you willing to devote time and money to training?

15) Are you willing to treat this dog like part of the family?

16) Have you ever owned a pet before?

17) What type of pet?

18) Where are they now?

19) Are there pets in the home now?

20) What type?

21) Are they spayed and/or neutered?

22) Are they current on vaccines?

23) Are they on heartworm prevention? What brand?

24) Are they on flea and tick prevention? What brand?

25) What brand of food do you feed your pet?

26) Does your pet live: (reply "yes" to the most applicable answer)
indoors
outdoors  
both

27) Will your new pet be living: (reply "yes" to the most applicable answer)
indoors
outdoors
both

28) Is the pet a gift for someone?

29) Does everyone in your home want a new pet?

30) Are you willing to restrict your housing only to places that allow dogs?

31) Will you walk the dog on a leash?

32) How many hours a day will the dog be left alone?

33) How long will the dog be left outside alone?

34) Are you planning on crate training the dog?

35) If not how are you planning on housebreaking?

36) Where will the dog sleep at night?

37) Where will the dog stay when you go on vacation?

38) Who will be primarily responsible for the dogs daily care?

39) Has anyone in the household ever had an allergy to animal hair?

40) Do you have a veterinarian?  
Name
Phone#

41) Personal Reference name

 Phone#

42) How will you prevent fleas and ticks?
Heartworm?

43) Please complete this sentence: I would give up my pet if:

Thank you for taking the time to answer these questions all applications will be reviewed and require a home visit/interview before the dog is permanently placed.

Answer "yes" if you attest that answers to all above questions are true to the best of your knowledge.

 

Please note that Companion Animal Rescue reserves the right to refuse adoption.

If you have completed and are satisfied with your application, click "Submit".  A new page will open confirming your application has been sent.  Please print a copy of the confirmation page for your records.