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501c3 non-profit organization in CONNECTICUT
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Fostering a Rescue Dog
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SubFostering
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Volunteering Choices
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Owner Turn-In
Support Us
Information
Transport Services
Health
Clinic Locations
Vaccination Requirements
Spaying/Neutering
Education
Dog Food
Myth of Normal Dogs
Buying A Pet
Safety
Microchip
Toxic Foods For Dogs
Pet-Friendly Places
Pet Friendly Rents
Pet Friendly Guide
Pet Friendly Groomer
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ALL DOG LISTINGS
Available Dogs
German Shepherds
Tails of Success
Applications
Adopting a Rescue Dog
Fostering a Rescue Dog
Fostering
SubFostering
Volunteering
Volunteering Choices
Transportation
Owner Turn-In
Support Us
Information
Transport Services
Health
Clinic Locations
Vaccination Requirements
Spaying/Neutering
Education
Dog Food
Myth of Normal Dogs
Buying A Pet
Safety
Microchip
Toxic Foods For Dogs
Pet-Friendly Places
Pet Friendly Rents
Pet Friendly Guide
Pet Friendly Groomer
About Us
Contact Us
Adoption Application
ADOPTION APPLICATION
YOU MUST AGREE TO THE FOLLOWING IN THIS SECTION * PLEASE TAKE NOTE OF SOME COMMON PROBLEMS APPLICANTS HAVE REPORTED
#1. NUMBER & PHONE FIELDS FORMAT
*
Number fields are numbers ONLY; Phone fields are entered as xxx-xxx-xxxx
I understand
#2. DID YOU RECEIVE MY APPLICATION
*
When you submit your application, you will receive a copy of your application with all the questions and your answers in your email.
I understand
#3. EMAIL COPY OF APPLICATION
*
Check your email and bulk folder and if there is not a copy , then unfortunately, we did not receive it.
I understand
Dog Alternative
Dog Name - 1st Choice
*
What dog are in interested in?
Dog Name - 2nd Choice
What other dog would you be interested in?
Alternative Choices - Many applicants think they are not approved, that is not the case.
On many occasions we have many approved applicants that all want the same dog. Also, in many cases we have dogs that are a better match for the families and their lifestyles.
If the dog you are applying for is not a good fit for your family, would you consider a dog we recommend?
Strongly Consider
Consider
Neutral
Would Not Consider
Other
Please explain or other comments
Applicant Information
First Name
*
Last Name
*
Age - Numbers Only
*
Mobile Phone
Numbers 222 222-2222
Home Phone
*
Numbers 222 222-2222
Work Phone
Numbers 222 222-2222
Apt, Suite, Bldg.
Optional
Street Address
*
We cannot process your application without a complete street address with your house number and street name
Email
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Select State
Zip Code
*
ONLY numbers - sample: 1234567891
Applicant Employer
*
Applicant Occupation
*
Applicant Work Schedule
*
Co-Applicant
First Name
Last Name
Age
Mobile Phone
Numbers 222 222-2222
Work Phone
Numbers 222 222-2222
Relationship to Applicant
Email
Employer
Occupation
Work Schedule
Background
How did you hear about us?
*
What is your timeframe for adoption?
*
Where else have you applied?
Please list organization name
Why do you want a rescue dog?
Be as specific as possible.
Dog Preferences
Dog Sex
*
Male
Female
Either
Preferred or required
Preferred
Required
No Preference
If sex is required, explain.
Dog Age - Check all that apply
Baby (0-6 months)
Baby (6 months-1 year)
Young (1-2 years)
Young (2-3 years)
Adult (3-6 years)
Senior (7+ years)
If required, please explain.
Dog Size - Check all that apply
Small (0 - 40 lbs.)
Medium (41 - 65 lbs.)
Large (66 - 90 lbs.)
X-Large (91+ lbs.)
If size required, explain.
EnergyLevel/activity level desired - Check all that apply
High
Moderate
Low
Total couch potato
Would you be interested in adopting a bonded pair?
Yes
No
List in order the characteristics you want in a dog:
Check the behaviors or characteristics that are not acceptable (please bear in mind the majority of RESCUE dogs need obedience training to some degree, need work on basic leash skills, house manners, and may not be house trained)
Not Acceptable - Check all that apply
Alpha/Dominant
Needs Obedience training
Requires Fencing
Medication Dependent
Excessive Barking
Mouthing
Separation Anxiety Issues
Timid/Scared
Physically Handicapped, 3 legs or 1 eye
Other
List any other unacceptable behaviors.
Previous Dogs You Have Owned
Have you ever owned any kind of dog before?
*
Yes
No
Have you ever owned a rescue dog before?
*
Yes
No
Do you have any other animals?
Bird, horse, etc.
Where did you rescue your previous dog?
Please list name, city & state of organization
For each animal you own, please list:
Breed
Sex
Age lived
Have you ever - Check all that apply
Had a pet become lost?
Had a pet poisoned?
Sold a pet?
Had a pet killed by a vehicle?
Had a pet treated for a disease?
Surrendered a pet to a shelter?
Other
IF YES, TO ANY OF THE ABOVE, EXPLAIN IN DETAIL
YOUR APPLICATION MAY NOT BE CONSIDERED FURTHER WITHOUT ADEQUATE DETAIL
Current Pet(s) In Your Household
For each animal that you own, please list:
Pets Names
Breed
Age
Gender
Spayed or Neutered
What food(s) does your current dog eat?
How often?
Are all pets up-to-date on vaccinations (this is a requirement for adoption)?
Yes
No
If "no," please explain why not.
List preventative treatments current pets receive and frequency of dosage:
Have you and your dog gone to training? Describe your experience and if you accomplished your objective.
Have you had any other training previously with other pets? Describe your experience and if you accomplished your objective.
Where would you enroll your next dog for obedience training if it is needed?
Describe your experience introducing an adult dog into your home to your current pets.
Dog Care Information
How will your dog be exercised and how often do you plan to provide this exercise?
How often and under what circumstances will your dog be left unattended outside?
How often and under what circumstances will your dog be allowed to be off-leash?
Do you have a tie out or runner for your dog?
Yes
No
If yes, you MUST explain how and when it is used:
How many hours a day on average will the dog be home alone without adults?
Will the dog be primarily kept:
Indoors
Outdoors
Will your dog:
Be crated
Be kept in a dog house
Have the run of the house
Be tied or attached to runner outside
Be in a blocked-off portion of the house
Where will the dog be kept when no one is at home?
What provisions will be made for your rescued dog during those times?
Where will your rescued dog sleep?
Household
Do you live in a:
*
House
Townhouse
Duplex
Condo
Apartment
Other
Do you have a yard?
Yes
No
What is the size of your yard--area for dog?
Is it completely fenced?
Yes
No
What is the height and type of fence?
Dog safety and exercise plan
If no fence or partial fencing how will your dog will be allowed to exercise, play, and relieve him/herself while being kept from running away, getting lost, or getting hurt?
Renters * Must Choose Rent or Own Below
Complete this section if you rent your residence.
CONDO/TOWNHOUSE OWNERS – WE WILL NEED TO SEE A COPY OF YOUR BY-LAWS TO ENSURE YOU ARE ALLOWED TO ADD A PET TO YOUR HOUSEHOLD.
Do you rent or own? Required, must choose one
*
Rent
Own
Do you have permission to keep a large dog?
Yes
No
YOU WILL NEED TO PROVIDE YOUR LANDLORD’S NAME AND CONTACT INFORMATION, AS WELL AS A NOTARIZED LETTER STATING YOU HAVE PERMISSION TO KEEP A DOG OVER 50 POUNDS.
Landlord's Name
Name of Landlord or Housing Manager
Company Name
Name of Apartment or Company
Phone
ONLY numbers sample: xxx xxx-xxxx
Landford Email
Apt, Suite, Bldg
Optional
Street Address
City
State
Choose State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Children & Household Members
PLEASE NOTE: WE DO NOT RECOMMEND YOU INVOLVE YOUNG CHILDREN IN THE PROCESS UNTIL YOUR ADOPTION IS APPROVED AND A PARTICULAR DOG HAS BEEN FOUND TO BE THE BEST MATCH FOR YOUR FAMILY. IT IS YOUR RESPONSIBILITY TO PROTECT YOUR CHILDREN FROM BEING HURT OR CONFUSED IF AN ADOPTION DOES NOT HAPPEN.
How many children in the house?
Ages of children in the house
Describe their (children’s) experience/exposure to large dogs:
How often do you have young children visit (grandchildren or friends of children)
If you have children, what precautions will you take to ensure children and the dog(s) can co-exist safely?
How many adults live in the household? - Number Only
Other then applicants
Ages household members in the household
Other then applicants
Relationship other household members to applicant(s)
Does everyone in your household want to get a rescued dog?
Yes
No
Who will be responsible for the care of the dog?
Who will be responsible for the training?
How will the children and household members be involved with care of dog?
Is anyone in your household allergic to animals? Please specify cats, dogs, long hair etc
Yes
No
If yes to allergic and/or gift, please explain:
Travel and Moving
How often do you travel and who will care for your dog when you are away?
Please note if person is related or daycare
Are you willing to travel more than 2 hours to pick up your dog?
Yes
No
Will this dog be a gift?
Yes
No
If the dog is a gift, then for whom?
Does the recipient know?
Yes
No
Are you planning to move in the near future?
Yes
No
Whenever you DO move, what will you do with your dog?
If yes, please explain:
Current Vet Information - Required Fields
IF YOU DO NOT HAVE A VET, PLEASE ENTER THE VET'S INFORMATION BELOW WHERE YOU WILL TAKE YOUR DOG TO FOR VACCINATIONS * PLEASE CALL THEM AND LET THEM KNOW THAT YOU WANT ADOPT A DOG AND SET UP AN ACCOUNT FOR THEIR SERVICES
Current Vet Name
*
Organization
Never Had a Vet - Check New Vet
*
New Vet
Current Vet
Phone - Numbers Only Format XXX XXX XXXX
*
Apt, Suite, Bldg
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Previous Vet Information
Past Vet Name
Organization
Phone
Numbers 222 222-2222
Apt, Suite, Bldg. (optional)
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Getting To Know You
Why is this question essential?
The application you just completed is very important however, the questions tell us all about your life. The question below is important because it helps us get to know you and in many cases helps us with our decision. You could be a wonderful applicant but we won't know unless you tell us here.
Most Important Question
Please use this space to tell us anything about you which you think may be helpful. Please remember, only the best applications are selected for our dogs - here is your chance to tell us why yours is one!
Here are some suggestions:
If you had dogs before, what was that experience like that moved you to continue to want a dog in your life? Why did you spend hours on end looking for a dog? What will this dog do for you and most important, what will you do for this dog. In the end, who really rescues who?
Planning For Your Dog
Make sure your pet has a happy future - this section is not a requirement.
What happens if you can no longer take care of your dog or any of your pets? Don't leave your dog to others to take care of. As a rescue, we come across this problem so many times and the family that is left to deal with loss of a family member and an additional beloved family pet is an emotional burden that can be take care of by you. Please consider making arrangements for your pets with someone. If you have someone, please let us know.
First Name
Last Name
Home Phone
Numbers 222 222-2222
Cell Phone
Numbers 222 222-2222
Email
Apt, Suite, Bldg.
Optional
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Wyoming
Wyoming
West Virginia
Zip
New Owner Information
What is the relationship of the new owner to you?
Friend
Family
Other
Are other family members or your attorney aware that:
Made arrangements for your pet
Plan on making arrangements
Other
Has your current or previous pets met them?
Yes
No
Other
Do they have other pets?
Yes
No
Unsure
Other
What current or previous pets have been with then new owner: Cat, dog, horse etc
TERMS AND DISCLOSURES
Call Your Vet
You will call your vet and give them permission to speak with us right after your application is submitted.
I agree
Home Visit
Allow a rescue volunteer to complete a home visit in order to approve adoption and at least one follow up visit after adoption?
I agree
Medical Agreement
Your rescued dog must ALWAYS be kept on monthly heartworm prevention for the first 12 months consecutively you have him/her, and as recommended by your vet thereafter.
I agree
Removal
We reserve the right to remove a dog at any time should we find the adopter is no longer caring for their rescued dog n in a way we see fit. We also require adopters to agree to follow up visits as needed. We are committed to our dogs before, during and after adoption!
I agree
Authorization
By submitting this form I hereby authorize a Rescue Dog Village Guardian, Inc. representative to verify all information provided on this form and give your veterinarian permission to disclose all medical information requested.
I agree
Accuracy of information provided
All of the information I have given in this questionnaire is true and complete. Should a rescue animal be placed with me, it will reside in my home as a pet. I agree to provide all necessary veterinary care, food, shelter, love (including hugs and kisses) and an ample supply of tennis balls, affection and care!
I agree
Signature
By entering my signature here, means I have agreed to all the terms in this form and agree that Rescue Dog Village Guardian, Inc. are released and indemnified from any and all claims, known or unknown, now or hereafter arising in connection with any dog placed in your home.
I agree
Submission of an application DOES NOT guarantee a dog will be placed with you.
I agree
THE FEE INCLUDES ALL VACCINATIONS, ANY NECESSARY MEDICAL TREATMENTS, KENNELING AND TRANSPORTATION COSTS AND ARE SUBJECT TO CHANGE AT THE DISCRETION OF RESCUE DOG VILLAGE.
If you have any questions, please ask.
Signature
*
Enter your full, legal name.
Phone
Numbers 222 222-2222
Instructions
Section
Verification
Please enter any two digits
Example: 12
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please leave it blank
Rescue Dog Village Guardian, Inc.