Date *

Today's Date

MM

DD

YYYY

Adoption Date *

When will you be ready for your new dog to come home?

MM

DD

YYYY

Adopter's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone Number *

(###)

###

####

Cellphone Number *

(###)

###

####

Annual Household Income *

$0 - $30,000

$30,000 - $60,000

$60,000+

Current Address *

House

Apartment

Condo

Mobile Home

Do you own or rent your home? *

Own

Rent

Is everyone in the household in agreement to adopt this animal? *

Yes

No

Have you had to euthanize a family pet? *

Yes

No

Will you crate your new dog? *

Yes

No

Have you used a dog trainer? *

Yes

No

I am willing to adopt a dog that needs training *

Yes

No

Maybe

I am willing to adopt a very outgoing or hyper dog *

Yes

No

Maybe

I am willing to adopt a very shy dog *

Yes

No

Maybe

I am willing to adopt a dog that needs regular medication *

Yes

No

Maybe

I am willing to adopt a dog that needs grooming *

Yes

No

Maybe

Would you use a dog trainer if there are any issues with your new dog? *

Yes

No

Do you have a doggy door? *

Yes

No

Do you have a fenced in yard? *

Yes

No

What is the activity level in your home? *

Very quiet

Quiet

Active

Very Active

Will you commit to this dog for its lifetime despite changes in your life?

Yes

No

Would you attempt to resolve behavior problems with training prior to surrendering a dog? *

Yes

No

Maybe

Is anyone in your home allergic to animals?

Yes

No

What would cause you to return this pet? *

Allergies

Moving

Job change

New baby

Got married/divorced

House training issues

Aggressive behaviors

Personal health issues

Dog health issues

Vet bills

Not compatible with other pet

Kids not taking care of dog

Does not play ball/fetch

Dog chews furniture/carpet/household items

No reason to get rid of a dog

Other

I understand that adopting a rescue dog is for the lifetime of the dog. SDR reserves the right to refuse any application/adoption for any reason. A mandatory home visit will be conducted prior to any animals being placed for adoption. *

Yes

No