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: Amy Aura Basil Ben Ellie Sue Gerry Heather Jack & Jill Joey Jose Lucky Mama Mia Monica Perry Riff Salem Soup Veronica Willow

Which additional are you applying for?
Choose an animal: Amy Aura Basil Ben Ellie Sue Gerry Heather Jack & Jill Joey Jose Lucky Mama Mia Monica Perry Riff Salem Soup 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:*