Adoption Application

Thank you for your patience and time completing this questionnaire. The purpose of this questionnaire is to select the most compatible home for all of Rosie's dogs. We will process your questionnaire as soon as possible. Occasionally we experience delays in returning correspondence and processing applications/questionnaires.

We appreciate your patience as we have no paid staff and our volunteers work hard trying to keep delays to a minimum.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Home Phone * - ### - ### ####
Cell Phone - ### - ### ####
References
Reference Name *
Reference Phone Number * - ### - ### ####
Veterinarian Name
Veterinairian Phone Number - ### - ### ####
Animal you presently have at home

If you have no animal at home, skip to next section.
Type of Animal
Breed/Mix
Age(s)
Sterilized?
Yes No
Provide details of the dog(s) you have had in the past

If you never had a dog in the past, skip to next section.
Breed/Mix
What happened to the dog(s)?
What type of dog are you inquiring about?

Tell us about the type of dog you are interested in adopting.
Breed/Mix *
Colour *
Age *
Puppy 1-3 years old 4-7 years old 8 and up No Preference
Fur Type *
Short Medium Long Non-Shedding No Preference
Size (weight) *
1-20 lbs 21-50 lbs 51-90 lbs 90+ lbs No Preference
Activity Level *
Low Energy Medium Energy High Energy No Preference
Gender *
Male Female No Preference
Names of the Available Rosie dog(s) you might be intrested into *
If you are interested in a specific breed, have you researched this breed? *
Yes No
Tell us about yourself and your experience with dogs
1) What kind of residence do you live in? *
House Apartment Condo Townhouse Farm Live with Parents Other
1b) If you rent or live in a condo, does your Landlord/Condo Association consent to your having a dog? *
Yes No Not applicable
2) How many adults live in your residence? *
2b) How many children live in your home? *
2c) If you have child/children, what are their ages? *
2d) Are you planning on having a child/children within the next 5 years?
Yes No
3) Do you have friends/family with children under 6 who visit? *
Yes No
3b) If Yes, How old is/are the child/children who visit?
4) Does anyone in your home have allergies to dogs or cats? *
Yes No (Skip to question 5)
4b) If Yes, Is this person allergic to dogs or cats?
Dogs Cats
5) Do you have a fully enclosed fenced yard? *
Yes No
5b) If No, do you plan on installing a fence?
Yes No
6) How many hours a day will the dog be left alone? *
0-2 3-5 6-7 8-10 10+
6b) If you are gone more than 5 hours, will you:
Return home part way through day Hire a dog walker Leave dog alone all day
7) Where will the dog be when alone? *
Loose in house Crate/Cage Room/Penned Area Garage Outside/Dog House
8) How and where will you have the dog exercise? *
Backyard Public Park/Dog Park Walk Running/Biking/Dog Sports Other
9) How much time per day do you intend to exercise your dog? *
10) Where would you teach your dog to go to the toilet? *
Backyard/Walks Paper/Litter Other
11) Are you prepared to work with a dog that might require some level of toilet training? *
Yes No
12) Are you familiar with Crate/Cage Training? *
Yes No
12b) Will you use this method? *
Yes No I don't know
13) How would you deal with issues such as dominance, digging, chewing, or separation anxiety? Please explain... *
14a) Have you ever given up a dog or cat to a shelter, pound, or rescue group? *
Yes No (Skip to question 15)
14b) If yes, provide the circumstances which forced you to do so:
15) Do you understand that you must work with your pet(s) and a new dog to make an addition work? *
Yes No
16a) Have you ever taken a Basic Dog Obedience Course? *
Yes No
16b) Will you be attending Basic Dog Obedience Course with this Dog? *
Yes No Maybe
Where did you hear about Rosie?
Please specify where you head about us (if TV/Radio Show or Other)

Adoption Application

Adoption Application

References

Animal you presently have at home

Provide details of the dog(s) you have had in the past

What type of dog are you inquiring about?

Tell us about yourself and your experience with dogs