ADOPTION APPLICATION
For Starbuck - Washington State
 

Thank you for your interest in adopting a rescue dog. The dogs available for adoption are screened for temperament and health. All dogs have been given their vaccinations, started on heartworm and flea preventative and have been spayed or neutered. Although, we cannot guarantee that there are no problems with the dogs in rescue, we have done our very best to assure that each dog adoption is a good candidate for a new family. We want our dogs and our adoption families to be happy with the placement.

The following application is very important to helping us make the perfect match between dog and new "parent". We reserve the right, at our sole discretion, to turn down an application. By submitting this application via the Internet, you are giving us permission to check the references listed and demonstrating your sincere interest in pursuing the adoption.
 

Please answer ALL questions on this application. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.

Form will not work if *required* spaces are not filled.

 

Name:*required

Street Address:*

City:*State:*Zip:*

Home Phone:* Work Phone:   

Email Address (REQUIRED):*

Applicant’s Employer: 

Position:  

Phone: 

Co-Applicant’s employer: 

Position:  

Phone: 

 

1) How did you hear about Washington rescue

 
If other, please indicate

3) Why do you want to adopt? Please give all reasons that apply (companion, guard dog, gift, to breed, personal protection, for children, other).  Do you have a preference (coat, color, sex, age)

4) How long have you lived at the above address?

5) Do you rent or own your current home?

6) What type of home do you currently live in?                                                    

7) If you rent, please provide us with your landlord's name and phone number.
Please note that we will contact your landlord.

8)If you move to a location that does not accept dogs, what will you do?

9) If you have children living in your home or that visit on a regular basis, please indicate their name, sex, and age(s).

10)Are there other adults in the household  

11)If other adults in the household, do they all approve of getting a dog  

12) Have you ever owned a dog?

13)Do you understand this dog will stay with you for the rest of his life?                                                    

14)If you have other animals, please fill out the section below:
  Breed: Age: Spayed/Neutered?

Breed: Age: Spayed/Neutered?

15)If you have owned animals in the past, what happened to those animals?
 

16)Do you take your pet to a vet annually?                                                      

17) Are your current pets current on their vaccinations and heartworm preventative (where applicable)?

18) Are you familiar with heartworm preventative and the vaccinations that are necessary?
 

19) We require that all animals adopted from us be spayed/neutered. If you have any questions/concerns/reservations about this policy, please explain below.

20)Are you prepared for the possibility of more than routine vet bills and care of the dog?                                                     

21)If you have animals in the house that are not spayed/neutered, fully vaccinated, and on heartworm/flea prevention medicine - please explain.

22) Please provide us with the name/address/phone number of your veterinarian. We will call them for a reference.

23) Do you have a fenced yard?

24) What kind of fencing do you have?

25) If you DO NOT have a fence, how will your dog be exercised and go to the bathroom?                                                    
If other, please indicate

26)Would you allow a home visit by a volunteer?                                                     

27) Where do you plan on keeping your dog the MAJORITY of the time?                                                    
If other, please indicate

28) Where will your dog sleep at night?
If other, please indicate

29) What will you do with your dog where there is no one at home?
If other, please indicate

30) What will you do if your dog exhibits bad behavior? ie..being destructive, soiling the house, barking, etc.

31) Do you understand that this dog may not be housebroken and are you willing to take the time to properly housetrain?

32) Do you understand that it may take this dog time (at least 30 days) to adapt to his new environment and family?

33) What are your preferences for your adopted dog? ie..age, sex, color, etc.

34) Would you be willing to adopt a dog with a medical condition (allergies, thyroid problem, etc). Note..we will not adopt out a dog with a major medical problem such as cancer.

35) Would you be willing to adopt a dog with a behavior problem (chewing, separation anxiety, fear of thunderstorms, not housebroken, etc.) Note..we will not adopt a dog that is aggressive or has bitten before--under ANY circumstances.

36)Did you see a particular dog on our website that you are interested in? If so, please indicate in the below space.

37)Please give 2  professional references.

38) Please write any additional comments below. Use this space to also indicate any health or behavior problems that you could NOT handle (dog aggression, cat aggression, daily medication,etc.)

By submitting this form you acknowledge and agree to the terms below:
Adoptee being of lawful age, do now release, acquit and forever discharge Washington Rescue, its Agents and Assigns, from any and all actions, claims, demands or damages accruing to me resulting from any known or unknown injury, loss or damage, sustained by me as a result of acting as a adopter. 
I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE  DOG FROM MY HOME