Dixie Pet Underground Railroad Posted on January 5, 2014 kelseyPosted in form Adoption Application Please Note: We are committed to matching the right dog to the right family so all will have many happy years together. Our adoption process includes the completion of an application, phone interview, veterinary reference, adoption fee and contract. The standard adoption fee is $500 and includes your pooches transport as well as his vetting. Your adoption fee will be billed to you via Pay Pal after your application is approved. You must be at least 18 years old to submit this application. The application is the first step in the process, and the fastest way to begin the process is to submit your completed adoption application via email to firstname.lastname@example.org. By submitting this application, you are consenting to a background check to investigate any history of animal abuse or criminal record that may preclude you from adopting a pet. This is done only to ensure the safety of the animal.< Your Name (required) Co-Applicant: Your Email (required) Name of Desired Pet Preferred Tel. (required) Alt. Phone (required) Address (Street, Town, State & Zip Code) AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Place of Employment How did you hear about Pooches on the Move? ---PetFinderGoogleNewspaperFacebookFrom a Friend Why do you want a rescue dog? How far are you willing to travel to pick up your rescue dog? Please tell us about your household & family members! List the humans, including their names in ages, and then your other pets including dogs (name, gender, age, breed, altered?), cats (name, gender, age, breed, altered?) and other pets (type, name, age) Do all household members want to adopt a dog? YesNo If there are no young children living in your home, will your rescue dog have regular contact with any under the age of 10? YesNo If yes, describe: If there are no other animals currently living in your home, will your rescue dog have regular contact / socialization with others? YesNo If yes, describe: Do you own or rent your home? OwnRent How long at current residence? If you rent, has your landlord provided written permission for you to have a dog? YesNo Please provide your landlord’s name & phone #: Do you have a fenced yard? YesNo If yes, please describe: If you don’t have a fence, are you willing to install one? YesNo Do you have dog tie-outs? YesNo Do you have overhead runs? YesNo If yes, length: Does anyone in your household have allergies or asthma? YesNo If yes, who/kind? Are you aware that dogs can shed all year long? YesNo Who will care for, train and exercise your rescue dog? How will you exercise your rescue dog? If you do not currently have a dog, have you ever owned a dog in the past for which you were the primary caretaker? YesNo If yes, what happened to the dog? Have you ever sold, given away, surrendered or put down a pet? YesNo If yes, please explain: Who is your veterinarian? Please provide name and phone number. Where will the dog live? Where will the dog sleep? Where will the dog eat? Will the dog be allowed on the furniture? YesNo Will your dog be allowed free run of the house? YesNo How many hours per day will your dog be home without humans on a regular basis? Where will the dog be when you are not home? Are you familiar with the use of a dog crate to train and/or confine the dog during your absence or at night? YesNo Are you planning to use a crate? YesNo What will you do with your dog(s) if you need to be away from home overnight? Are you aware that costs of maintaining a dog can average $500 or more a year (food, annual check ups & shots, heartworm & flea/tick prevention, grooming, etc.)? YesNo Will the rescue dog….. be tied outside? YesNo live outside? YesNo be walked daily? YesNo allowed to run free outside of a fenced yard?YesNo have annual vet check-ups? YesNo receive formal obedience training? YesNo If you move, what will you do with your dog(s) and other pets? May we visit your home prior to the application approval? YesNo Would you allow a follow-up home visit from a representative before and after this adoption? YesNo Are you aware of and do you understand the state/local ordinances concerning dog licensing? YesNo Leashing / leash laws? YesNo Has any member of your household been citied for licensing or leash law violations? YesNo Would you call Pooches On The Move at the onset of any type of illness or health problem within 30 days following this adoption? YesNo What would you do if one of your pets requires significant medical attention? Preferences of the rescue dog you'd like to adopt: Age: 2-6 months6-12 months1-2 years3-5 yearsSenior Sex: MaleFemale Size: SmallMediumLargeExtra Large Activity/Energy Level: LowMediumHigh Breed/Mix: Color: Would you consider a special needs or handicapped dog that may require medication for a permanent (but controllable) condition? YesNo Anything you would like to add? By submitting below, I/we understand that this is the first step of the adoption process. I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we have retained a copy of this application for my/our records and understand that completion and submission of this application does not guarantee or entitle me/us to adoption of a rescue dog.