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Dog Pre-adoption Application

First Name:
Last Name:
Address:
City:
State:
Zip:
Email Address:
Home Phone:
Work Phone:
Cell Phone:
Are you: Under 21     21-25  26-35  36-59 
60+ (Senior discount may apply)
Driver's License Number:   State:
How many adults in household?:
Do you have children who visit?:
How many children under 18?:   Ages:
Have you adopted from us before?:
What has happened to the pets you have owned in the past 5 years?:


RESIDENCE INFORMATION
Type of home: Other desc:  
Do you own your home?  If so, how long?: 

If you own your condo/townhome please check with your homeowners' association regarding their pet policy.


Do you rent?  If so, how long?: 
Are there pet weight/breed restrictions? Please specify?:


FAMILY INFORMATION
Is this dog for?: Yourself     Children  Family  Gift  Protection 
Companion for pet at home 

Who will ultimately be responsible for the feeding, socialization and training of the dog?:
Under what circumstances would you not keep this dog?:
Note: RCHS will always take their pets back if needed and will place in a new home.
Describe the personality of your ideal dog: Active   Couch Potato   Mellow   Social Butterfly   Cuddly  Athletic  Independent
Other:
On a scale of 1-5 rate your family: 1=Couch Potato     5=Supersonic
Would you like information on specific training issues?: Please specify?:
How many animals do you have at home?: Dogs  Cats  Rabbits  Other 

Do any family members have allergies specific to animals?
When outdoors how will the dog be confined?: (check all that apply) Fence    Zip-Line    Invisable fence    Chained      Dog kennel  Leash   Other
Time away from home:
Do you have a yard?
(A yard is not a requirement for adoption)
Height of fence?:
Type of fence?:

Please list all pets residing at your home (including roommate's pets).

Breed/Type Age Sex Spayed or Neutered Time Owned Where is pet kept

Please describe the specific location:

Where will the new dog be kept when your are not at home?

Where will the new dog be kept when you are at home?

Where will the new dog sleep at night?:

When do you anticipate these changes in lifestyle?:

Moving:

Having children:

Acquiring other pets:

Other changes:

Names of dogs you are interested in meeting:

PLEASE READ THE FOLLOWING CAREFULLY
I hereby certify that the above information is true. I understand that any falsification discovered during the adoption process may result in the nullification of this adoption. I understand that this dog may live 15+ years and I am prepared to give it the medical and emotional care and support that it needs. In addition, I understand that dog expense ie food, medical care, vaccinations, licensing, training and supplies may average $1200+ annually. Adoptions are based on best match, thus this application may not necessarily result in the adoption of the animal(s) listed above. Please know that the staff at RCHS strive to achieve the most successful match for both dog and prospective family.
BY SUBMITTING BELOW I ACKNOWLEDGE HAVING READ THIS APPLICATION, ANSWERED ALL QUESTIONS AND FULLY UNDERSTAND THE RESPONSIBILITY OF ADOPTING A PET.

After you have reviewed your application please type RCHS into the box for security purposes:

If you feel your application is complete, click on the button marked Submit Application.