RAIN of Central Illinois, Inc. Adoption Application

Applicant's name *

Which dog are you applying to adopt? *

If there is already an application in for this dog, is there any other dog you may be interested in? *

Employer *

Email address *

Phone number *

Address *

City *

State *

Zip *

May we text you? *

Yes

No

Do you rent or own your place of residence? *

Rent

Own

If you rent, please provide your landlord's name and phone number *

Please provide ages of all children living in your home *

If you have young children, are you willing to educate them on how to properly interact with this dog? *

Yes

No

N/A

Are your pets spayed/neutered? *

Yes

No

If not, please explain why *

What are the BREEDS and ages of all dogs living in your home? N/A, if none. *

What are the ages of all cats living in your home? N/A, if none. *

Are your pets kept current on flea/tick and heartworm preventative? *

Yes

No

N/A

What is the name of your veterinarian? *

Veterinarian's phone number *

Have you ever surrendered an animal to a shelter, police station or PERSON? *

Yes

No

If so, please explain why. *

Have you ever returned an adopted or purchased animal? *

Yes

No

If so, please explain why. *

Have you ever been denied adoption from a shelter or rescue? If so, please list why. *

Have you adopted before? If so, through what group(s)? *

What would cause you to return a dog? *

Would you be willing to work with a trainer prior to returning your dog? *

Yes

No

Have you or anyone in your household ever been charged with animal cruelty or neglect? *

Yes

No

Who will be responsible for the feeding/daily care of this dog? Who will financially support this dog? *

Why are you interested in this dog? *

Where will you keep this dog? *

Where will this dog go when you travel? *

How many hours will this dog spend alone a day? *

Would you object to a home visit? *

Yes

No

Are you over 18 years of age? *

Yes

No

Will this be an outdoor dog? *

Yes

No

If this will be an outdoor dog, please indicate which of the following he/she will be provided with *

How will you exercise this dog? *

How do you plan to train/socialize this dog? *

How will you keep this dog confined to your property? Check as many as apply *

How did you hear about RAIN? *

If adopting a bully, what experience do you have with bully breeds? *

Personal reference 1 name *

Phone number *

Personal reference 2 name *

Phone number *

Do you consent to a background check? *

Yes

No

Additional notes, comments or questions *

I certify the above is true and that false information may result in nullifying this adoption. R.A.I.N. of Central Illinois has the right to refuse adoption to anyone. I understand that no animal can be held for me.

Signature and Date *