First Name *

Last Name *

Address Street 1 *

Address Street 2

City *

Zip Code *

State *

Home Phone *

Cell Phone *

Email *

Occupation *

Employer *

how long at current job? *

If less than 1 year, previous employer and length of time *

Spouse/Significant Other *

How many adults in your home? *

Their names and ages *

Your age *

How many children in your home? *

Their names and ages *

If no children, do you plan on having any, and if so, when? *

Does anyone in the home have any animal related allergies? If so, please explain *

What type of home do you live in? (select one from list) Apartment Condo Mobile Home House *

Do you own or rent? *

If you rent, please provide the name and phone number of landlord so that we may confirm that pets are allowed *

How long at current address? *

Are you planning on moving in the next year? If yes, please explain: *

Previous address (if less than 2 years at current address) *

Do you have a fenced yard? *

If you have a fenced yard, please provide approximate measurements and fence type and height *

Which best describes the are you live in? Rural City Urban Suburban *

Do you have a pool or pond on your property? *

If you have a pool or pond, please explain type. Is it fenced? If so, what type of fence? *

Do you have air conditioning? If so, what type? *

Is someone home at all times or will the dog need to be alone for a portion of the day? If so, how long and where exactly will the dog stay while alone? *

What is the plan for when you travel or go on vacation? *

Do you agree to allow a rescue agent to visit your home prior to adoption? *

Have you owned a dog before? *

How many dogs have you owned in the last 5 years? *

Do you currently have any other dogs? *

List name, breed, age, and gender of each of your current pets (dogs, cats, etc.) *

What happened to your last dog? (Please explain if lost, stolen, given away, died - age and cause, etc.) *

If your last dog was given away, please explain the circumstances and provide the name and address of the person to home the dog now belongs *

Are all of your animals (dogs/cats) on heartworm preventative and flea and tick control? *

What brand? *

Are your pets spayed/neutered? *

Are your pets up to date on vaccinations, or have you had a titer test performed on them within the last year? *

Why do you want a dog? *

Would you prefer male or female? *

Do you want a specific breed? *

Are you familiar with the health issues common to brachycephalic or "short-nosed" dogs? If yes, please explain *

Would you consider adopting a dog with a treatable health condition (i.e. heartworm)? *

Would you consider adopting a dog with a disability (i.e. deaf, blind, missing limb, heart condition, etc.)? *

Would you consider adopting a dog that may have some aggression issues and/or a bite history needing continued patience and training? *

Would you consider adopting a mix? *

What age range are you looking for? *

How far will you travel to adopt a dog? *

Where will the dog spend most of each day? *

Where will the dog sleep? *

What brand of dog food will you feed? *

What do you expect to be the annual costs involved in veterinary care for a dog? *

What other expenses do you expect to pay? *

How do you plan to exercise your dog? *

Please list hobbies and activities that you will be including your dog in (i.e. running, boating, biking, etc.) *

Obedience training may be a REQUIREMENT for some adopted dogs. Are you willing to attend obedience classes with your dog, if needed? *

Have you ever obedience trained a dog before? If so, describe your method used *

Have you ever housetrained a dog before? If so, describe your method used *

What is your definition of disciplining a dog? *

How would you handle a dog's destructive behavior? For example, dog chews furniture or gets into garbage, etc. *

If you cannot keep the dog for any reason, will you return it to its foster parents? *

What circumstances, in your opinion, justify getting rid of a dog? *

Veterinarian (name, address, phone) *

Personal Reference #1 (name, address, phone, relationship, years acquainted) *

Personal Reference #2 (name, address, phone, relationship, years acquainted)

Personal Reference #3 (name, address, phone, relationship, years acquainted)

Why do you feel a rescue dog would be the right choice for you? *

Please tell us why you would make a great home for a dog, in particular the dog for which you are applying? *

How did you hear about our organization? *

Are you currently working with any other rescues? If so, please provide the name, phone and email address so that we may combine our efforts *

Would you be interested in becoming a SNORT volunteer? If so, please specify the activities you are interested in helping with *

Further comments or additional information that you feel might help us find the right dog for your home

By typing my full name here, I hereby agree not to hold SNORT or any of its volunteers liable for any physical, emotional or property damages that are a direct or indirect result of activities involved with a SNORT rescue dog. This includes but is not limited to dog bites upon meeting/greeting the dog, adopting or fostering, transport, grooming, training or evaluation of the dogs in any way associated with SNORT and its rescue process *