Name

Address 1

Address 2

City   State   Zip

Home phone     Work phone

Email      Fax #

I live in a     House Condo Apartment Other With Parents

How long at this address ?  years and  months

Own   Rent   Lease

If you rent or lease please be aware that  a copy of the lease will  be requested, or a landlord check completed before an adoption will be finalized.

Do you have a fenced yard ?  Yes  No

Approximate size of fenced area

Type of shade in the area ?

Is fence attached to house ?   Yes   No

Will thedog ever be left outside unattended?   Yes   No

How will the dog be exercised ? 

Would you like  recommendations on the safe confinement of your new Dalmatian ?
  Yes    No

I have already made the following arrangements

May we visit your home ?    Yes    No

Why do you want a Dalmatian?

What attracted you to the Dalmatian?

What other breeds have you considered?


Are you looking for a    watchdog?    companion    obedience work/competition? playmate for another dog?  for a child, or as a gift for others 

Do you prefer Male/female under 1 year--1-3 years---3-5 years---over 5 years Liver or Black ?

Please Briefly explain why you would provide a good home for a rescued Dalmatian

For your needs, what are the three characteristics that you find most appealing about the Dalmatian?  Choose 3, number the choices 1 for best, 2 for second best and 3 for third best

? 1 2 3 active       ? 1 2 3 shy      ? 1 2 3 playful       ? 1 2 3 calm        ? 1 2 3 independent 

? 1 2 3 intelligent  ? 1 2 3 loving  ? 1 2 3 dominant   ? 1 2 3 other      ? 1 2 3 submissive

other

Have you or your spouse owned a Dalmatian before?   Yes    No

How long ago?  years

What happened to it?

Have you ever given away or sold a dog before and why?

Have you ever surrendered a dog to a shelter and why?

I have children, ages

Other people in home 

Where will dog be housed during the day night

Feelings about crate training/  use and do you own one ?


How long will the dog be alone each day ?

How much time a day would be spent playing/training dog

What other animals do you have now ?

Type breed age sex   neutered/spayed ? Yes No

Type breed age sex   neutered/spayed ? Yes No

Type breed age sex   neutered/spayed ? Yes No

Type breed age sex   neutered/spayed ? Yes No

Type breed age sex   neutered/spayed ? Yes No

Type breed age sex   neutered/spayed ? Yes No

Where are these animals kept ?

What other animals have you had in the last five years?


What happened to them? ( if  your pets have passed away, please give us the age and cause of death)



What kinds of problems, if any, did you have with them?

Would you be willing to take dog to obedience classes?   Yes    No

If 'No', please explain.

Name and phone number (including area code) of your current Veterinarian:

May we contact your Vet?    Yes    No

List name and phone numbers of other Veterinarians that you have used in the past

Please list 3 names and phone numbers other than a relative of someone that we may contact as a personal reference. These may include neighbors, breeders, trainers, co-workers etc.

Have you applied to adopt from any other Dalmatian rescues ?    Yes    No

Name(s)

1 - I AGREE THAT IF I CAN NOT KEEP THE ADOPTED DALMATIAN FOR ANY REASON I WILL RETURN THE DOG TO YOU IMMEDIATELY.

2 - I CERTIFY THAT I AM AT LEAST 18 YEARS OLD, HAVE READ THIS APPLICATION IN ITS ENTIRETY AND HAVE UNDERSTOOD AND ANSWERED EACH QUESTION TO THE BEST OF MY ABILITY.

3 - I UNDERSTAND THAT OWNING A DOG IS A COMMITMENT FOR THE DOGS LIFETIME AND IF I ADOPT A DOG FROM YOU I AM WILLING TO MAKE SUCH A COMMITMENT.

4 - I UNDERSTAND THAT I MAY NEED TO SIGN A VETERINARIAN'S INFORMATION RELEASE FORM AND MAIL IT IN. 

5 - I AGREE THAT I HAVE NOT NOR HAS ANY OTHER PERSON LIVING IN OUR HOUSEHOLD, BEEN CHARGED WITH ANY FORM OF ANIMAL ABUSE, NEGLECT OR CRUELTY?  (EVEN IF THE CHARGES WERE LATER DROPPED OR FOUND GUILTY).

Agree Don't agree

Name(s) of applicant(s)

Date:

     In order to help fund the Vet care for the dogs in our program, there is an adoption fee of $200.00 for adults and $250.00 for puppies.

Are you willing to help us by fostering some of our dogs until “Forever Homes” can be found?

Thank you for taking the time to fill out this questionnaire. We will review it as soon as possible.  To speed up the adoption process, make sure you answer all the questions on the application, incomplete applications will not be answered.  We do not work on a first come, first serve basis, dogs are adopted to the best quality home for that particular dog.  Please only click the submit button once.