Smiley Dog Rescue ... Adoption Application

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Dog Adoption Application

Notes:
1. Required fields are indicated with
2. We limit our adoptions to the immediate San Francisco Bay Area, only occasionally are exceptions made.

Applicant Information

* First Name:
* Last Name:
* Address1:
Address2:
* City:
* State:
* Zip:
* Phone (day):
* Phone (eve):
* Email:
How did you hear about Smiley Dog Rescue?

Want to be notified about Smiley Dog Rescue Special Events?
	Yes No
Want to be notified by email about new dogs that are available? (You can unsubscribe latter if so desired.)
	Yes No

* Please indicate in the box below that you are aware that there is a $175 adoption fee that is collected for all adoptions to defer costs for the care and medical treatment of adoptable dogs.

Indicate your Adoption Fee Awareness

Background Information
* 1. Name of dog or breed you wish to adopt:
* 2. Why do you want to adopt a dog?
* 3. Which dog you are looking for?	Breed: Age range: Size: Gender:Male Female Either Color: Hair: Activity level: Types of activities you want to do with dog:
* 4. Where will the dog be when No one is home?
* 5. Where will the dog be when someone is home?
* 6. How many hours will the dog be home alone?
* 7. Do you have an fenced in yard?	Yes, No if Yes, How tall is the fence? What type of fence?
* 8. Where would you prefer the dog to sleep?
* 9. Is anyone who will live with the dog allergic to dogs?	Yes, No if Yes, please explain
* 10. Do you plan to exercise your dog?	Yes No if Yes, how?
* 11. Are you planning to obedience train your dog?	Yes No Not sure
* 12. Who will be primarily responsible for the dog’s care?
* 13. Do all members of your household want a dog?	Yes No if No, who is not in favor?
* 14. Have you ever relinquished a pet to an animal shelter or to anyone else?	Yes No if Yes, when and why?
* 15. What will you do if your dog develops behavior problems?
* 16. Are there any behaviors that your dog would do that would cause you not to be able to keep him/her in your guardianship for the rest of his/her life?	Yes No if Yes, please explain
* 17. Do you currently have a veterinarian?	Yes No If Yes, please fill in below so we may contact the vet for references Vet Name: Address: City: State: Zip: Phone:
* 18. Do you understand that you will be sharing your life with a dog for 14 - 18 years, who is totally dependent upon you for food, shelter, health and veterinary care? Are you willing and able to make this life-long commitment to a dog as a family member? Yes No

Family Information

* 19. Indicate the number of adults in your household.

What are the ages of the adults?

* 20. Indicate the number of children in your household.

If you have children, what are the ages of the children?

* 21. Do you have children that visit you?

If children do visit what is their age range?

* 22. Please identify the number of pets you currently have.

List each pet below:

	Type of Animal	Age	Sex	Spayed/ Neutered	Where Pet Lives
a.
b.
c.
d.
e.

* 23. Besides the pets listed above, please list the number of all animals you have had in the past 5 years.

List each animal below:

Type of
Animal

Age

Sex

Spayed/
Neutered

Where Pet Lives

What happened?

  a.

  b.

  c.

  d.

  e.

* 24. Where will you and your dog live?

* 25. Do you own or rent?

own rent

If you rent, fill in the info below:

Landlord's name:

Landlord's phone:

Dog size limits:

* 26. Do you have a back up plan for your dog/cat if you die or have to move and can not take your dog with you?

* 27. If you are unable to be at home with your dog for a lengthy period of time (i.e., vacation, emergency travel, or travel for work) who will take care of the dog in your absence?

* 28. Would you agree to a home visit to ensure it is secure for the pet?

Yes No

Please read and certify the following:

By submitting this form I certify that all information in this application is true, and I understand that false information may void this application. I agree that upon adopting a pet from Smiley Dog Rescue, I will agree and abide by their Adoption Agreement.