First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Country

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

What is your occupation? If you have a partner, what is his or her occupation?*

Are there children or other adults living in your home? *

List the names and ages of all adults and children in the home:*

Your home address where the dog will live is what type of residence?*

Do you own or rent this residence?*

If you rent, please provide your landlord's name, address, telephone number and the best time to contact him/her. Note verification of pet rules for renters is a condition of adoption, so you must supply this information.*

Do you have a second residence? Please provide contact information.*

Do all adult family members in the household agree on the adoption of this dog?*

Why are you looking to adopt?*

Is there a specific dog that interests you?*
Choose an animal: Carson Gizmo Nala Orion Toi

Is there a specific dog breed that you are interested in adopting? If so, please provide this information*

Are you willing to adopt a dog with special needs, such as blindness, deafness, other diseases/conditions/health problems or an older dog? If yes, please elaborate:*

Are you willing to adopt a dog with house training issues?*

Please explain your views on crate training dogs, including the maximum time your dog would be crated in a day.*

Where will the dog sleep at night?

How many hours a day [maximum time] will the dog be left alone?*

Where will the dog be kept during the hours it is left alone?*

Where will your dog stay when you are out of town?*

 A veterinary reference is mandatory. If you or your vet refuse to release your vet information, your application will be rejected.   Please let your vet know that we have your permission to call them.

Please provide your current vet's name, address, phone number and hours of operation.*

Please list your past vet's name, address, phone number and hours of operation.*

We require and check personal references.  Please provide your references below.

Personal Reference 1: Please provide the name, contact information [telephone numbers and email address] and best time to reach your personal references.*

Personal Reference 2: Please provide the name, contact information [telephone numbers and email address] and best time to reach your personal references.*

Please provide a description of the fence (chain link, wood, wrought iron, vinyl, and height) around you yard.*

Is your yard securely fenced?*

If you do not have a fenced yard, please describe how you intend to safely exercise your dog and provide potty breaks.*

Do you have a pool in your yard?*

Is the pool in your yard above or in-ground? Please describe the safety features you have for your pool [fence - type, height, locked], alarm, pool cover, etc.] that will prevent your dog from falling in and drowning.*

Please list all current pets living in your home. Please include name, type, breed, age and size of pet.*

Please list all other animals owned within the past 5 years that are not currently living in your home. Provide information on what happened to them and reasons for any deaths.*

Have you ever given an animal away?*

If you have given an animal away, please explain the circumstances that led to you decision and how you placed the animal.

Have you ever adopted an animal before?*

Please provide the name of the rescue/shelter and contact information for any animal you have adopted, and the current status of the adopted animal

Do you understand that rescue dogs have, in all likelihood been abused, neglected, mistreated, and/or abandoned [and because of this, extra care and patience is needed in areas of housetraining and socialization]?*

How would you react if your dog destroyed a household object or soiled in the house?*

Home visits are required for adoption from A PROMISE OF LOVE. If you answer NO, your application will not be processed.

Are you agreeable to a home visit?*

Are you agreeable to meeting the dog you wish to adopt prior to the actual adoption, if the dog is in your near vicinity?*

We know that at time circumstances arise in a family that affect their ability to keep their dogs. Do you understand that, it for any reason, you are not able to keep your dog, you are contractually required to return the dog to A PROMISE OF LOVE at your expense?*

Our dogs are fostered throughout the United States. We do allow adoptions throughout the country. However, if the dog and adopter are not located near each other, it is the responsibility of the adopters to arrange for transportation if they are not picking up the dog themselves. We can help arrange for transportation through various networks and, sometimes free of cost through volunteers. However, we cannot guarantee that all transports arranged can be free of cost. You are responsible for any costs associated with transporting your new dog. We do not allow our dogs to be shipped as cargo.

Are you 18 years or older?*

By submitting this application, I hereby certify that all of the information provided is accurate, to the best of my knowledge.

I understand that by typing in my name below, along with the date, A PROMISE OF LOVE accepts that, and I agree to its use, as an acceptable substitution for my written signature.

Date: *

Signature of Applicant:*

Signature of Co-applicant:*