RESCUE DOG VILLAGE
Adoption Application Form
APPLICANTS INFORMATION
***ATTENTION***
 IF YOU HIT ENTER AT ANY TIME WHILE YOU ARE FILLING OUT THIS FORM,
YOU WILL LOSE ALL OF YOUR INFORMATION AND HAVE TO START OVER
****THE "SUBMIT" BUTTON IS AT THE END OF THE FORM****
Please tell us what dog(s) you are interested in:   Can you please tell us what other dog you would be interesed in:  
Your First and Last Name:   Your Age: (both applicants must be at least 21 years of age)  
Co-Applicant Name:   Co-Applicant Age:  
Relationship to Applicant:   Your Address:  
Your City:   State:   Your Zip:  
Your email address:   Home Phone:  
Work Phone:   Cell Phone:  
Applicant Employer:   Applicant Occupation:  
Applicant Work Schedule:  
Co-Applicant Employer:   Co-Applicant Occupation:  
Co-Applicant Work Schedule:  
How did you hear about us?  
What is your time frame for adoption?   Where else have you applied?  
Why do you want a Rescue dog? Please be as specific as possible:  
DOG PREFERENCES
Dog Sex: Male
Female
 Preferred or Required: Preferred
Required 		If sex is required, please explain:  
Dog Age: (check all that apply to the left of the age range, please)    0 to 6 Months      6 months to 1
   1 to 2 Years  2 to 3 Years    3 to 6 Years
   Senior (7+)Years      No Preference
 Other:  
Dog Size - you can select more then one. Small (45 to 55)    Medium (55 to 65)    Large (65 to 80)   
X-Large(80 Up)    No Preference
 If size is required, please explain:  
EnergyLevel/activity level desired:  High       Moderate       Low       Total couch potato
 Would you be interested in adopting a bonded pair? Yes  No
List in order the characteristics you want in a dog:  
Please check what is not acceptable: Jumping  Chewing  Mouthing  Timid/Scared   High Energy  Alpha/Dominant  Counter Surfing  Requires Fencing 
Excessive Barking         Not House Trained         Not Leash Trained
Separation Anxiety Issues        Needs Obedience training 
Medication Dependent - Seizures, Thyrod       
Physically Handicapped - 3 legs, 1 eye
 Other:  
PREVIOUS DOG EXPERIENCE/CURRENT PET INFORMATION
Have you ever owned any kind of a dog before?   Have you ever owned a rescue dog before?   From where did you rescue your previous dog?  
For each animal that you own, please list - Breed:   Sex:   Age lived:  
Have you ever: Had a pet who became lost?   Had a pet poisoned?   Had an animal killed by a vehicle?   Had an animal treated for a disease?   Had an animal die due to disease?
Sold, given away, or surrendered a pet to a shelter?
IF YES, TO ANY OF THE ABOVE, PLEASE EXPLAIN IN DETAIL (YOUR APPLICATION MAY NOT BE CONSIDERED FURTHER WITHOUT ADEQUATE DETAIL)   Do you have any other dogs or cats?
For EACH animal please list:
Your Pets Name(s):   Type:(breed for dogs)  
Age:   Gender:   Spayed or Neutered:  
Describe your experience introducing an adult dog into your home to your current pets.  
What food(s) does your current dog eat, if applicable?   33a. How often?  
Are all pets up-to-date on vaccinations (this is a requirement for adoption)?   If "no", please explain why not:  
List preventative treatments current pets receive and frequencyof dosage:  
Describe your experience with training your previous dogs:  
Where do you plan to enroll your next dog for obedience training if it is required?  
HOUSEHOLD AND DOG CARE INFORMATION
Do you live in a:              House                Townhouse                Duplex                Condo                Apartment                Other
Do you rent or own?   If you rent, do you have permission to keep a large dog?  
IF YOU RENT, YOU WILL NEED TO PROVIDE YOUR LANDLORD’S NAME AND CONTACT INFORMATION, AS WELL AS A NOTARIZED LETTER STATING YOU HAVE PERMISSION TO KEEP A DOG AND THE STIPULATIONS SURROUNDING SUCH.
Landlord's Name:   Address:  
City:   State & Zip:   Phone Number:  
Do you have a yard? What is the size of your yard?  
Is it completely fenced? What type of height and fencing?  
If no fence or partial fencing how will your dog will be allowed to exercise, play, and relieve him/herself while being kept from running away, getting lost, or getting hurt? (be as detailed and specific as possible – describe HOW you plan to do this and what you will use)  
How will your dog be exercised and how often do you plan to provide this exercise?   What will you do if your dog needs more exercise than you planned?  
How often and under what circumstances will your dog be left unattended outside?  
How often and under what circumstances will your dog be allowed to be off-leash?  
Do you have a tie out or runner for your dog? If yes, you MUST explain how and when it is used:  
Other than the applicant(s), how many adults in the household?   Ages of other household members (other than applicants) and relationship to applicant(s)  
How will they be involved with care of dog?  
How many children in the house?   Ages of children in the house:  
Describe their (children’s) experience/exposure to large dogs:  
If you have children, what precautions will you take to ensure children and dog or dogs can co-exist safely:  
PLEASE NOTE: WE DO NOT RECOMMEND YOU INVOLVE YOUNG CHILDREN IN THE PROCESS UNTIL YOUR ADOPTION IS APPROVED AND A PARTICULAR DOG HAS BEEN FOUND TO BE THE BEST MATCH FOR YOUR FAMILY. IT IS YOUR RESPONSIBILITY TO PROTECT YOUR CHILDREN FROM BEING HURT OR CONFUSED IF AN ADOPTION DOES NOT HAPPEN.
Who will be responsible for the care of the dog?   Who will be responsible for the training?  
How many hours per day will the dog be home alone without adults?   Where will the dog be kept when no one is at home?  
What provisions will be made for your rescued dog during those times?  
Will the dog be primarily kept: Where will your rescued dog sleep?  
Will your dog: Be in a blocked-off portion of the house   Have the run of the house   Be crated  Be tied or attached to runner outside   Be kept in a dog house
What type of dog training experience do you have?  
How often do you travel?  
Who will care for your dog when you are away?  
Will this dog be a gift? If the dog is a gift, then for whom?   Does the recipient know?
Does everyone in your household want to get a rescued dog? Are you willing to travel more than 2 hours to pick up your dog?
Are you planning to move in the near future?   If yes, please explain:  
Whenever you DO move, what will you do with your dog?  
Is anyone in your household allergic to animals? If yes, please explain:  
Are you willing to allow a rescue volunteer to complete a home visit in order to approve adoption and at least one follow up visit after adoption?
Do you accept that the total adoption fee for dogs is $500, and this includes transport fees to the Northeast if applicable? Yes  No
Do you agree - Adopters are entitled to a refund of their adoption fee less $50 provided they deliver the living dog to a representative of Rescue Dog Village within 14 days of the date of adoption. Should the dog's appearance or condition have been significantly altered by the adopter, Rescue Dog Village reserves the right to deny a refund.  I agree
 I do not agree
Do you agree - Rescue Dog Village is not responsible for nor shall refund any and all expenses (medical or otherwise) incurred by the adopter after the date of adoption regardless if the adopter wishes to return the dog.  I agree
 I do not agree
THE FEE INCLUDES ALL VACCINATIONS, ANY NECESSARY MEDICAL TREATMENTS,
KENNELING AND TRANSPORTATION COSTS AND
ARE SUBJECT TO CHANGE AT THE DISCRETION OF RESCUE DOG VILLAGE.
If you have any questions, please ask.
QUESTION CURRENT VETS PAST VETS USED
Name
Address
City
State, Zip
Phone
Please use this space to tell us anything about you which you think may be helpful. Please remember, only the best applications are selected for our dogs—here is your chance to tell us why yours is one!  
TERMS AND DISCLOSURES
Do you agree to the following:
Adoptions are completed with the signing of an adoption contract.
Under the terms of the contract, a Rescue Dog Village dog may NEVER be given away or sold and MUST be returned to Rescue Dog Village in the event you are no longer able to care for the dog.
Your rescued dog must ALWAYS be kept on monthly heartworm prevention for the first 12 months consecutively you have him/her, and as recommended by your vet thereafter.
We reserve the right to remove a dog at any time should we find the adopter is no longer caring for their rescued dog n in a way we see fit. We also require adopters to agree to follow up visits as needed. We are committed to our dogs before, during and after adoption!
By submitting this form I hereby authorize a Rescue Dog Village representative to verify all information provided on this form and give your veterinarian permission to disclose all medical information requested.
All of the information I have given in this questionnaire is true and complete. Should a rescue animal be placed with me, it will reside in my home as a pet. I agree to provide all necessary veterinary care, food, shelter, love (including hugs and kisses) and an ample supply of tennis balls, affection and care!
By entering my signature here, means I have agreed to all the terms in this form and agree that Rescue Dog Village are released and indemnified from any and all claims, known or unknown, now or hereafter arising in connection with any dog placed in your home.
Submission of an application DOES NOT guarantee a dog will be placed with you.
Signature   Date of Applicaton   Your Email  

After you have entered all the informaiton, please click the submit button: