Southern California
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oSCAR DE LA RENTA
Contact
Adoptable Dogs
Adoption Form
ADOPTION APPLICATION
Pet Interested in
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Full Name
*
Complete Address: REQUIRED to process application
*
Applicants Date Of Birth
*
E-mail
*
Phone (Mobile/Text)
*
Phone (Home)
*
Phone (Work)
*
Best Time To Call (And Which Number To Call)
*
Name Of Co-Applicant / Spouse / Significant Other / Roommate
D.O.B. of Co-Applicant /Spouse / Significant Other / Roommate
Relationship To You (Select one)
*
You must select an option
Spouse
Significant Other
Single
Widowed
Roommate
Parent
Child
Caretaker
Your Occupation
*
Occupation of Co-Applicant /Spouse / Significant Other / Roommate
If this relationship were to end with whom would the dog(s) remain?
Who will be primarily responsible for the care of the dog(s)?
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Do You Have Children?
*
Yes
No
Do They Live With You?
*
Yes
No
Have They Been Around Dogs?
Yes
No
List their ages (separated by a comma)
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If You Do Not Have Children Now, Do You Plan On Having A Family In The Future?
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Yes
No
If Yes, When
If You Already Have Children, Do You Plan To Have More In The Future?
If Yes When?
What Our Your Reasons For Adopting A Dog?
*
You must select an option from dropdown menu
Companion For You
Companion For Your Dog
Spouse
*Gift (For Whom?)
*Other
*Gift/Other: Explain
*
I Would Consider Dogs (Check All That Apply)
With Special Needs
With Behavior Issues
That Has Been Abused
That Is A Senior
That Is Deaf / Blind
That is not yet housetrained
What Are The Qualities You Are Looking For In A Dog(s)
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Have you adopted from a different rescue group? (not asking about the humane society/shelter)
Does Anyone In The Household Smoke?
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Yes
No
Are You Prepared To Pay $40+ Every 4-6 Weeks To Groom Your Dog(s)?
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Yes
No
In Your Selection, What Is Your Preference? (Breed,Sex,Age,Color)
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Are You Familiar With The Characteristics / Temperament Of This Breed?
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Yes
No
My Ideal Pet:
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What Concerns, Do You Have About Adopting?
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Type Of Dwelling?
*
You must select an option
Apartment
Condo
Mobile Home
House
Duplex
Townhome
Do You :
Rent
Own
Pets Allowed?
*
Yes
No
Yes, with landlord approval
Unsure if pets are allowed
Years At Residence?
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Do You Have A Landlord / HOA?
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Yes
No
If You Have One, May We Contact Your Landlord / HOA?
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Yes
No
I Don’t Have One.
If No, Please Explain :
Landlord / Owner / HOA (Name,Phone#)
*
Where Will The Dog(s) Stay During The Day?
*
You must select an option from dropdown menu
Run Of House / Indoor Only
Run Of House W/ Dog Door To Go Outside
In Backyard / Outdoor Only
Outside Dog Run / Outdoor Only
Designated Area Only
Kennel
Other, Explain :
If The Dog Is Indoors Only, What Access Does He / She Have To Outside?
How Many Hours A Day Will The Dog(s) Be Left Outside?
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What Outside Space Is Available For The Dog(s)?
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If Fenced Yard, What Type?
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You must select an option
Chain Link
Block Wall
Vinyl
Picket Fence
Wood
Wrought Iron
Outdoor area is semi-secure
None, Outdoor areas are not fenced
*Other, please explain at end of application
*Other
Height
*
Do You Have A Grassy Area?
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Yes
No
Do You Have A Pool?
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Yes
No
If So, Is The Pool Fenced?
Yes
No
Do not have a pool
Other Access Areas For Dog(s)
*
You must select an option from dropdown menu
Garage
Balcony
Un-fenced Yard
Pet Door
Kennel Run
Patio
None
*Other
*Other :
Will The Dogs Be Tied Up?
*
Yes
No
Where Will The Dogs Sleep?
Outside Dog House
On The Bed
Dog Bed In Bedroom
Child's Room
Floor
Kitchen
Laundry Room
Garage
In a cage / crate
*Other
*Other :
Any Areas Where The Dog(s) Will Not Be Allowed?
*
Are You Planing A Move In The Next Six Months?
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Yes
No
If So, Please Explain :
If You Ever Had To Move Would Your Dog(s) Move With You?
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Yes
No
Unknown
Past Present Pet History
Do you currently own a dog(s)
Yes
No
Number Of Dogs In Household?
*
Any Other Animals In Home?
Have You Had A Dog(s) In The Past 10 Years?
Yes
No
When, Please Explain :
If So, Where Are They Housed?
History Of Dogs Owned (List Breed, Gender, Size, Age, Medical Problems And Why You No Longer Own Them) :
*
Has Your Dog(s) Been Vaccinated?
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Yes
No
Will You Provide Annual Vaccinations?
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Yes
No
Depends
If No Or Depends, Please Explain :
Will You Provide Necessary Medical Care?
*
Yes
No
Depends
If No Or Depends, Please Explain :
Veterinarian's Name, Phone Number, Address: (Current Or Most Recent) We Must Have This Reference To Process Your Application.
*
May Save A Bow Wow Contact Your Veterinarian?
*
Yes
No
If No, Please Explain:
How Many Hours Per Day Will Your Dog(s) Be Alone?
*
You must select an option
0-2
3-5
6-9
10-12
Explain:
Any provisions to let the dog(s) out during the day?
*
How Many Times Will The Dog(s) Be Walked Each Day?
*
You must select an option from dropdown menu
Once A Day
Twice A Day
Three times A Day
Four times A Day
Dog Door To Outside / No Walks
No Walks
*Other
*Other
How Will Your Dog(s) Spend The Day?
*
Do You Have A Friend Or Relative* Who Would Care For The Dog(s) If You Became Incapable Of Caring For Him/her For An Extended Period Of Time?
Yes
No
Please Provide Name, Relationship To You And Their Phone Number:
Will your dog(s) be allowed on the furniture?
*
Yes
No
Will You Become Frustrated If Your Dog(s) Is Not Housebroken?
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Yes
No
How Do You Plan On Housebreaking Your Dog(s)*?
What Would Make You Consider Giving Up Your Dog(s) (Check All That Apply):
Pets Don’t Get Along
Divorce
Medical Issues
Accident In The House
Dog Grew To Big
Not Obediant
Chewing
Moving
New Baby
Allergies
Shedding
Wouldn’t Give Them Up
*Other (Please Explain In Notes At End)
What Would You Do With Your Dog(s) If You Could Not Keep For Any Reason(s) Listed Above?
*
You must select an option from dropdown menu
Drop off at a Humane Society / Animal Shelter
Return To A Rescue
Return To Save A Bow Wow
Put To Sleep
*Other
*Other
If Your Dog Needed Acute Medical Attention Or Emergency Care Are You Prepared To Handle That Expense?
*
Yes
No
If Your Dog Needs Monthly Medication, What Amount Would You Be Willing To Spend?
*
$0
$1-25
$26-$50
$51-$100
$101+
Brachycephalic Breed Disclosure
Brachycephalic breeds have an inherent risk of medical needs due to genetic design.
I did not apply for a Brachycephalic breed
I do not know what a Brachycephalic breed is
I applied for a Brachycephalic breed and will order pet insurance protection
I applied for a Brachycephalic breed and will not get pet insurance
How Often Do You Travel, And Where Will You Dog(s) Stay When You Travel?
*
Additional Information ( Your Overall Health – Your Lifestyle, and any additional information you wish for us to take into consideration when your application is processed)
*
ADOPTIONS REQUIRE A HOME CHECK AND / OR DELIVERY OF THE DOG(S). THIS DOES NOT INCLUDE ANY ADDITIONAL TRANSPORT OR SHIPPING WHERE APPLICABLE PLEASE MAKE A COPY OF THE COMPLETED APPLICATION AND BRING IT WITH YOU TO ADOPTIONS. FOR BEST PRINT RESULTS, PLEASE SET PAGE ORIENTATION TO LANDSCAPE UNDER PRINTER PROPERTIES. PLEASE MAKE SURE YOU HAVE ANSWERED ALL THE QUESTIONS TO THE BEST OF YOUR ABILITY, AS THIS WILL ONLY HELP US IN DETERMINING THE RIGHT FIT FOR YOU. THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION. OUR GOAL IS NOT TO BE INVASIVE BUT TO MATCH THE BEST POSSIBLE HOME FOR EACH ANIMAL.
Verification
Please enter any two digits with no spaces (Example: 12)
*
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