Rescue Tails Animal Welfare

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Today's date:*

What is your age?*
Choose one: 21-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older

What are the ages of all adults and kids living in your home?*

Which pet(s) are you applying for?*
Choose an animal: Able Alexandra Alpha Amanda Amelia Amy Any animal not listed Aragon Aura Autumn Baker Bandit Basil Beatle Beau Becky Ben Beta Betsy Butters Charlie Colin Delta Ellie Sue Eowyn Ethel Fred Gerry Ginger Gordon Harriet Harrison Heather Herman Herman Jack & Jill Jenna Joey Jose Kelly Lee Legolas Lennon Lincoln Lucky Maddie Mae Mama Mia Maui McCartney Merry Millie Misty Monica Monroe Monty Morgan Patrick Perry Peter Riff Ringo Rocky Salem Sara Sara Seamus Sherman Sigma Simon Soup Stripe Sundra Taco Tamara Tauriel Tiny Tim Travis Truffles Veronica Willow

Which additional are you applying for?
Choose an animal: Able Alexandra Alpha Amanda Amelia Amy Any animal not listed Aragon Aura Autumn Baker Bandit Basil Beatle Beau Becky Ben Beta Betsy Butters Charlie Colin Delta Ellie Sue Eowyn Ethel Fred Gerry Ginger Gordon Harriet Harrison Heather Herman Herman Jack & Jill Jenna Joey Jose Kelly Lee Legolas Lennon Lincoln Lucky Maddie Mae Mama Mia Maui McCartney Merry Millie Misty Monica Monroe Monty Morgan Patrick Perry Peter Riff Ringo Rocky Salem Sara Sara Seamus Sherman Sigma Simon Soup Stripe Sundra Taco Tamara Tauriel Tiny Tim Travis Truffles Veronica Willow

How long have you lived at this address?*

Are you adopting for yourself or for someone else?*

Describe in detail the dog you’re looking for*

Will this be your first dog?*
Choose one: Yes No

What kind of pets have you had in the past?*

Which of these do you still have? (Include age, sex and breed.)*

Have they been spayed or neutered?*
Choose one: Yes No Don't Know

Are they current on vaccinations? *
Choose one: Yes No Don't Know

What happened to the pets you no longer have?*

Have you ever turned your dog in to a shelter?*
Choose one: Yes No

If yes, please explain:

Have you ever had a pet euthanized?*

If yes, please explain:

If you have pets, will they adjust to a new dog in the house?*
Choose one: Yes No Don't Know

Was your last dog obedience-trained? *
Choose one: Yes No Doesn't Apply

Will you take this pet for training?*
Choose one: Yes No

Why do you want this dog? (Check all that apply.)

Other (explain)

How many people live in your home?*

How many adults are in your family?*

How many children and ages*

Does any member of your household have an allergy to dogs?*
Choose one: Yes No

Does any member of your household have any physical challenges, noise sensitivities’ or emotional concerns that would make the care of an animal difficult or unsafe? *
Choose one: Yes No

If so, what might that be?

Is someone home during the day? *
Choose one: Yes No

If yes, who?

How many hours each day will the dog be without human companionship? Please explain:*

Where do you live? *
Choose one: House Apartment Condo Mobile Home Other

If other, explain:

Do you own or rent your home? *
Choose one: Own Rent

If you rent, may we contact the owner to obtain permission for this dog to live in your home?
Choose one: Yes No

Owner’s name and phone number:

Will you also provide a copy of your lease? *
Choose one: Yes No Doesn't Apply

What is your current occupation?*

Who is your current employer?*

Does your job require extensive travel?*

Do you or anyone in your household work from home?*
Choose one: Yes No Doesn't Apply

If yes, who?

Do you plan to have a dog walker?*
Choose one: Yes No

Do you have a completely fenced yard?*
Choose one: Yes No

Is there a gate? *
Choose one: Yes No

What kind of fence (material) and fence height:*

If no fenced yard, please explain:

Do you have a dog door?*
Choose one: Yes No

Are there times when the dog will be tied up?*
Choose one: Yes No

If yes, when?

Are there stairs that lead to your home?*
Choose one: Yes No

If yes, how many?

Will the dog spend any time in the garage?*
Choose one: Yes No

If yes, please explain:

Do you have a pool? *
Choose one: Yes No

If yes, is there a fence around the pool? What kind of fence and height of fence?

If your new dog/puppy is not housebroken, what method will you use to train him/her?*

Will you keep the dog up-to-date on vaccinations? *
Choose one: Yes No

If no, please explain:

Who is your veterinarian? (Please provide the name, phone number, city and state)*

Are you able and willing to exercise the dog on a regular basis? *
Choose one: Yes No

If yes, method of exercise:

Where will the dog be kept during the day?*

Where will the dog be kept during the night?*

If you drive a pickup truck, would you allow the dog to ride in the back?*
Choose one: Yes No

If yes, please explain:

If you go away for a few days, or on a vacation, who will take care of the dog?*

What arrangements will you make for the care of your pets in case of an emergency?*

If you move, will you take the dog with you? *
Choose one: Yes No

If no, please explain:

Have you ever applied to Rescue Tails before to adopt an animal?*
Choose one: Yes No

If yes, when?

Have you ever brought animals to Rescue Tails? *
Choose one: Yes No

If yes, please explain:

How did you find out about Rescue Tails?*

Are you willing to have a representative of Rescue Tails come to see where the dog will be living?*
Choose one: Yes No

If no, explain: *

Are you willing to take responsibility for this dog for the next 10 to 15 years? *
Choose one: Yes No

If no, explain:_

What provisions will you make for the dog should you become unable to care for him/her?*

Will you provide us the name and contact information of who would be willing to care for your pet and allow us to confirm this with that person(s)?*

Will you guarantee your caretaker has our information in the event they are unable to care for your animal? *

How much are you willing to spend on medical bills for your dog? *
Choose one: Up to $100 Up to $500 Up to $5,000 Whatever it takes

What would you do if the vet bills went over this amount?*

Please provide two personal references. Include name, address, street, phone number and email address and relationship for both personal references.*

Tell me about the pet food and treats you choose to feed your pets:*

Have you ever lost a pet? If so, what happened?*

Tell me about the other pets in your life, past and present: *

Tell me why you are interested in this pet:*