UnderDog Rescue of Florida

Name of dog interested in:

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Name:
Address:
City:		State:				Zip:
Phone:		Other Phone:
Email Address:		Your Age:

Please list the names, ages, and relationships of all other persons residing in your household:

Name:	Age:	Relationship:
Name:	Age:	Relationship:
Name:	Age:	Relationship:
Name:	Age:	Relationship:
Name:	Age:	Relationship:

Who will be the primary caretaker of the new dog?

Is everyone in the household agreeable to a new dog? Yes No

Does anyone in the household have allergies or asthma? Yes No

If you have frequent visitors, do you have a way to separate your dog from them if it is uncomfortable? Yes No

Explain:

Type of Residence: House - Own House - Rent / Lease Apartment Condominium Mobile Home Other

Do you live in a "Deed Restricted" area? Yes No

 

Landlord Information (only if you rent or lease):

Name:
Address:
City:		State:	Zip:
Phone:

 

 

 

If you do not have a yard, how do you plan to exercise the dog?

Do you feel it is acceptable to let your dog off-leash in an open area? Yes No

Have you ever housetrained a dog before? Yes No

If so, what method did you use?

Are you willing to housetrain? Yes No

Where will your dog be kept during the day?

Where will your dog be kept at night?

Are you interested in crate training? Yes No

How long will your dog be left alone during the day?

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Have you owned any dogs during the last 10 years? Yes No

If so, tell us about them:

What types of personalities do you find desirable in a dog?

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Are you willing to take a dog that is:

Not reliable with children? Yes No	Physically handicapped? Yes No
Requires ongoing medication? Yes No	Requires continued housetraining? Yes No
May have been abused? Yes No

 

 

 

Are you willing to adopt a bonded pair? Yes No

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Do you currently own pets? If so, please list them:

Name:		Name:
Breed:		Breed:
Age: Years Owned:		Age: Years Owned:
Gender:	Female Male	Gender:	Female Male
Kept:	Indoors Outdoors	Kept:	Indoors Outdoors
Fixed:	Yes No	Fixed:	Yes No
Bred:	Yes No	Bred:	Yes No

 

Name:		Name:
Breed:		Breed:
Age: Years Owned:		Age: Years Owned:
Gender:	Female Male	Gender:	Female Male
Kept:	Indoors Outdoors	Kept:	Indoors Outdoors
Fixed:	Yes No	Fixed:	Yes No
Bred:	Yes No	Bred:	Yes No

Will your pets accept a new dog into the household? Yes No

Are your pets current on vaccines? Yes No

Are your pets current on heartworm preventative? Yes No

What type of heartworm preventative are they on?

Have you ever given up an animal before? Yes No

If so, explain why:

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Please list your vet's information:

Name:
Address:
City:		State:	Zip:
Phone:

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Please provide 3 references:

Name:		Name:
Phone:		Phone:
Relationship:		Relationship:
Years known:		Years known:

 

Name:
Phone:
Relationship:
Years known:

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By completing this application and signing below and pressing the submit button, I certify that I am at least 21 years of age and will assume all responsibility for the care and well being for the animal that I am adopting through UnderDog Rescue of Florida.

I further agree that I will be contractually bound through adoption to:

• Take my dog to the vet at least once a year for an annual exam, shots, and heartworm check.
• Take my dog to a vet in a timely manner if ill.
• Maintain proper care, including monthly heartworm prevention and flea/tick treatments.
• Return my dog to UnderDog Rescue of Florida and ONLY UnderDog Rescue of Florida if for any reason I can no longer care for the dog in a loving and humane manner.

Please note that we must be given notice of 3 weeks to arrange to take a dog back.

 

Signature (Print Name):	Date: