Dog Adoption Application - Red Lake Rosie's RescueRed Lake Rosie's Rescue

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone

Work Phone

Cell Phone

Occupation*

Number of Household Members*

1. Member Name/Age/Relationship

2. Member Name/Age/Relationship

3. Member Name/Age/Relationship

4. Member Name/Age/Relationship

5. Member Name/Age/Relationship

6. Member Name/Age/Relationship

Number of Dogs

Number of Cats

What Type of Home Do you Live In?*

Do you rent or own?

If you rent, please give us the landlord's contact info, and let him/her know that we will be contacting them*

Are your pets spayed/neutered? If not, why?

Do you have time to provide adequate love, attention, and exercise?

Are your pets up-to-date on vaccines?

Have you ever surrendered a pet? If so, why?*

Have you ever had a pet euthanized? If so, why?*

Have you ever lost a pet to an accident? Please explain.*

How do you train/discipline your pets?*

Do you have a regular veterinarian?*

Veterinarian's Name

Clinic Name

Clinic Address

Clinic Phone Number

Which one of our animals are you interested in?

What is your idea of an ideal dog?*

Age?

Breed?

Size?

Sex?

Male
Female

Where will the dog spend the day? (describe)

Where will the dog spend the night? (describe)

Who will have financial responsibility for this dog?

Average number of hours the dog will spend alone daily?

Who will have primary responsibility for this dog's daily care?

Do you agree to provide regular health care by a licensed veterinarian?*

How will you provide exercise for this dog?*

Is your yard fenced?

What is the height of the fence?

Do you agree to keep this dog as an indoor dog?

Do you agree to contact RLRR if you can no longer keep this dog?

Are you willing to let a representative of RLRR visit your home by appointment?

How did you hear about RLRR?

Would you be interested in fostering a puppy/dog?

Would you like more information about fostering?

Please provide the names and contact information for two references who are not family members.*

A dog or cat MAY LIVE FOR 15-20 YEARS AND WILL NEED YOUR COMMITTED CARE FOR HIS OR HER LIFETIME! I certify that the information I have given is true. I realize that any misrepresentation of facts may result in my losing the privilege of adopting an animal from RLRR. I understand that RLRR has the right to deny my request to adopt an animal for any situation that would be contrary to the organization's adoption policies, in violation of any state or local ordinances, or not in the best interest of the animal, as determined by RLRR. I authorize verification of all statements in this application, and I also authorize my veterinarian to release any information requested by RLRR.*

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