ANIMAL RESCUE COALITIONS NOVA SCOTIA SOCIETY ADOPTION APPLICATION Date: Name of dog applying for: Full Name: Name of Employer: Full name of Spouse: Name of Spouses Employer: Complete Mailing Address: Email Address: Phone: (Home) (Work) *Please note an ID Tag is to be purchased from ARC with the dogs name and your phone number on it to be worn at all times. Please provide 2 personal references that we may contact: 1. Name: Relationship: Phone: Email: 2. Name: Relationship: Phone: Email: Please provide a veterinary reference that we may contact - (please phone vet and give permission for them to speak to us in regards to your pets health records): Name: Phone: Please answer the questions on the following pages as completely as possible. 1. Why do you want to adopt an animal? 2. What do you think are the most important responsibilities in owning an animal? 3. Why do you want to adopt this animal in particular (Breed, Size)? 4. Have you applied to any other shelters for another dog besides this one? 5. Do you have experience with a particular breed of dog? 6. Are you willing to take the time to work with a pet on any issues, should the need arise? 7. Do you understand and accept that changing an animal’s environment may cause the animal to have accidents, especially in the early days of the adoption? 8. If a behavioral problem arises, are you willing to consult an obedience trainer? 9. Does any member of the family have any allergies to animals? If yes, please explain: 10. For whom are you adopting the animal? (Self or Gift) 11. Have you ever owned a pet before? 12. If yes, what kinds of animal(s) and when? 13. Please describe in as much details as possible your current pet (age, sex, are they spayed/neutered and up to date on all vaccinations for the current year) 14. If not up to date on vaccinations please explain why? 15. Which pets do you no longer own? 16. What happened to him/her/them? If they were given away, why do you want another pet? 17. Were they spayed/neutered? 18. Have you done or do you intend to do any reading in preparation for a new pet? Please specify: 19. How many people currently reside in your household? 20. Are there children in your household, and if so what are their ages? 21. Do they have experience handling animals? 22. Do Children frequently visit your home? 23. Have you considered if the children in your home know how to properly interact with a new animal? 24. In the absence of the primary caretaker, who will take care of the animal? 25. How would you describe the activity level in your house (Loud, quiet, Calm)? 26. Are you prepared to meet the exercise and activity needs of this dog? 27. Do you own or rent your residence? 28. What will happen to the animal should you have to leave your current Rental? 29. What is the name of the landlord and the phone number? Are pets allowed? YES NO 30. Do you live in a - Single Family home, Duplex, Townhouse, Mobile Home, Condominium, or an Apartment? (Please describe) 31. Are there any restrictions where you live? 32. Please Estimate the Monthly cost of the following: Dog Food (what type do you currently feed?) __________________ Dog Treats _________________ Grooming___________________ Vet Care yearly____________________ 33. Are you able to comfortably provide the estimated care, and are you prepared for other emergency costs such as sickness, accidents)? 34. Do you accept that the RESCUER requires that all animals in the household be spayed/neutered before an adoption of a rescue animal can take place? 35. Do you accept that the RESCUER requires a non-refundable $250.00 donation for our animals? (This covers neuter and spay and first set of shots, all further boosters and yearly vaccines are your responsibility and are required to be kept up to date) 36. The average pet has a lifespan of 12 to 15 years. Are you willing to make a commitment to this pet for the rest of his/her life? 37. If, for any reason, you are unable to keep your animal, do you agree to notify RESCUER immediately to inform us of where the animal is going? 38. If this is a long distance adoption are you willing to travel to pick up the animal? 39. Will you consider Obedience Training for this animal? 40. Do you have any experience with obedience Training? 41. How do you intend to house break this dog (if not already housebroken)? 42. Who will be responsible for feeding and taking this dog outside? 43. Do you have a fenced yard? 44. Describe the fencing (height, materials, any holes or gaps)? 45. If you do not have a fence do you plan on getting one? If no please explain why? 46. How will you be letting your dog outside if there is no fence? 47. Would you walk your dog on leash or off or both? 48. Where will the dog be kept during the day? (If in a crate please explain why) 49. Where will the dog be kept at night? 50. How many hours will the dog be left home alone? 51. Will anyone be home during the day? 52. Where will the dog sleep? 53. Will you keep a collar on your dog with a tag bearing your name and number on your dog at all times? 54. Are you aware that you are required to register your dog according to county or city laws with a dog registration tag? 55. How often do you travel? 56. Where will the dog be when you travel? 57. What will you do with the dog if you move/change housing? 58. Have you ever bred or sold dogs in the past? 59. Please list any preferences you have in adopting an animal (age, sex, breed, personality, etc.): 60. Please list any concerns or final questions here: I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that the Rescue has the right to annul the adoption and reclaim the animal. I give the Rescue permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Rescue representative before an adoption decision is made. Furthermore, I understand and accept that the adoption decision depends upon many factors, including -- but not limited to -- the compatibility of the family and home to the individual animal and other applications received on the animal. I understand and accept that it is the Rescue’s prerogative to decide which home is most appropriate for the individual animal, and therefore I will not take issue with the decision. Unless otherwise indicated by the Rescue, I may be considered for another animal. Signed this ________ day of __________________________, 20________ -------------------------------------------------------------------------------------------- Applicant’s Name (Print) Applicant’s Signature -------------------------------------------------------------------------------------------- Rescuer (Print) Rescuer Signature -------------------------------------------------------------------------------------------- Applicant’s Address: -------------------------------------------------------------------------------------------- Phone # Day Phone # Evening -------------------------------------------------------------------------------------------- Email Fax Num