APPLICATION TO QUALIFY FOR DOG ADOPTION

Pet parenthood is a serious responsibility. Each person or family who adopts a pet must understand and accept the responsibility and commitment that pet parenthood requires.

This application form is designed to help Project POOCH, Inc., make the best possible placement of a dog into your home. The adoption process may take some time since Project POOCH, Inc., is committed to doing everything possible to match the right dog with your circumstances. It is hoped that you will be provided with all the information and support necessary for a successful adoption. Each dog at Project POOCH, Inc., looks forward to a lifelong home.

In order to assist in the adoption process, please complete the following application carefully and thoroughly. If you have any questions, do not hesitate to call the above telephone number.

If you would prefer to print this form, complete it, and submit it by mail, click here.

Section 1: Applicant's Personal Information

First Name *

Last Name *

Primary Phone Number *

Type *

Cell

Home

Work

Secondary Phone Number

Type

Cell

Home

Work

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Residence Details

Please tell us a bit about your living situation.

I/we *

Residence Type *

Do you have a yard? *

Since you do not have a fenced yard, how do you plan to ensure your dog gets exercise and potty breaks? *

Landlord's Name *

Landlord's Phone Number *

Time you have lived at your current address

Years *

Months *

Do you plan on moving soon? *

How many adults live in your household? *

How many children live in your household? *

Age, child #1 *

Age, child #2 *

Age, child #3 *

Age, child #4 *

Lifestyle Details

How did you hear about Project POOCH? *

Please tell us about your lifestyle and activities (do you hike, run, enjoy the outdoors, etc ...) *

Please tell us about your work schedule, including how many hours per day you are out of your home and how many days per week. *

If there will be someone at home when you are not, please provide information about that individual. Otherwise, enter N/A. *

Qualities Applicant Seeks in a Dog

Which POOCH dog are you currently interested in adopting?
(Enter the dog's name, not your name) *

Look at the name in the field you just entered—is it the dog's name or your name? Sometimes your browser will try to autofill that field with your name and it makes it really confusing when we try to process your application.

Why do you wish to adopt a dog? (check all that apply) *

What type of dog do you wish to adopt? (Check all that apply) *

Type of hair/coat *

Weight Range *

Breed or general type of dog *

Personality *

Why do you wish to adopt a dog from Project POOCH? *

Other Household Pets

Do you have pets currently living in your home? *

How many pets do you currently have living in your home? *

Are your pets current on their vaccinations? *

Please tell us why your pets are not current on their vaccinations. *

Pet #1

Pet #1: Type *

You selected Other. Please enter the type of pet you have. *

Pet #1: Sex *

Pet #1: Spayed/Neutered *

Pet #1: Age *

Pet #1: Kept In or Outside *

Pet #2

Pet #2: Type *

You selected Other. Please enter the type of pet you have. *

Pet #2: Sex *

Pet #2: Spayed/Neutered *

Pet #2: Age *

Pet #2: Kept In or Outside *

Pet #3

Pet #3: Type *

You selected Other. Please enter the type of pet you have. *

Pet #3: Sex *

Pet #3: Spayed/Neutered *

Pet #3: Age *

Pet #3: Kept In or Outside *

Pet #4

Pet #4: Type *

You selected Other. Please enter the type of pet you have. *

Pet #4: Sex *

Pet #4: Spayed/Neutered *

Pet #4: Age *

Pet #4: Kept In or Outside *

Veterinarian's Name *

Veterinarian's Phone # *

Name of Veterinary Clinic *

Have you had a pet within the last 10 years that is no longer with you? *

Please list all the pet(s) you have had in the last ten years, and include why the pet is no longer with you (died of old age, euthanized, rehomed, hit by car, etc ...

	Type of Pet & Breed	Reason Why No Longer With You
1	Type of Pet & Breed	Reason Why No Longer With You
2	Type of Pet & Breed	Reason Why No Longer With You
3	Type of Pet & Breed	Reason Why No Longer With You
4	Type of Pet & Breed	Reason Why No Longer With You
5	Type of Pet & Breed	Reason Why No Longer With You
6	Type of Pet & Breed	Reason Why No Longer With You
7	Type of Pet & Breed	Reason Why No Longer With You
8	Type of Pet & Breed	Reason Why No Longer With You
9	Type of Pet & Breed	Reason Why No Longer With You

Pet Care & Facilities

Do you have a fenced yard? *

What type of fence? *

Fence Height *

Will this pet be *

Indoor

Outdoor

Both

Unsure

Where will the dog be when you are home? *

Where will the dog stay when you are away? *

Where will the dog stay when you are sleeping? *

Training & Behavior

Important Note:

Any dog can be unpredictable. All dogs respond differently to people. All dogs placed for adoption by Project POOCH, Inc., often have unknown histories that training may not overcome.

Young Children MUST by supervised while in the presence of a dog.

As a potential adopter I *

Understand that ALL dogs may be unpredictable.

Understand that young children MUST be supervised while in the presence of a dog.

Would you be willing to spend time with the handler / trainer to learn about the dog? *

Would you be willing to continue training this dog? *

What type of training are you interested in pursuing? *

Is there anything else you feel necessary to share with us?

Application Certification

This certifies that the information contained in this application is true and complete. Through my signature below, I confirm that I agree to cooperate in the adoption process by providing medical care, training, and pet-related amenities as recommended by Project POOCH, Inc. Further, in the event that Project POOCH, Inc., places a dog in my household, I agree that before I sell or give up the dog, I will give Project POOCH, Inc., 15 days written notice at the above address to exercise its right of first refusal. *

clear

Signature Date * +