First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Alt Email

APPLICANT INFORMATION

How did you find our about The Street Dog Project?

Applicant's Date of Birth*

Name/Description of the dog you are interested in (i.e., are you interested in a particular dog we’ve been promoting on Facebook; do you prefer puppies, adults, certain sizes, gender, etc.? )

Why are you interested in adopting a pet at this time?*

What is the ideal personality of the dog that you would be interested in? Check all that apply

Additional comments regarding the traits you are looking for in a pet:

Who will be responsible for the care of the adopted dog?*

Number of adults living in the home?*

Number of children living in the home?*

Ages of children?*

Are there other children who regularly visit your residence?*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, are there any pet restrictions (breed, size, species, number, etc.) from your Landlord? Please specify.

If you rent, please enter your landlord's name and phone number

Do you have a yard?*
Choose one: Yes No

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence*
Choose one: No Fence Privacy (Wood) Iron Chain Link Invisible

What is the height of the fence

Is the fence gate kept securely locked?

Do you have a pool?*
Choose one: Yes No

Where will the animal be kept when you are home?*

Where will the animal sleep?*

What is the average number of hours per day the dog will be home alone?*

How often do you travel?*

How will the dog be cared for when you are out of town or away from home for an extended period of time?*

PET HISTORY - Please answer all questions about your history with pets, even if you have never owned a pet. Information about your experience with a friend or relative's pet is helpful.

What is your pet ownership history?*

How many pets have you owned or fostered in the last 5 years?*

What experience do you have with pets/animals?*

Have you ever house-trained a dog?*
Choose one: Yes No

What methods do you use to train/discipline your pets?*

CURRENT PET INFORMATION - Tell us about the pets currently living in your home. If you do not currently have pets, please skip to the next section.

Please list the name and species (dog, cat, fish, etc.) of your pet #1

Please list the age, weight, breed and personality of your pet #1

Gender of your pet #1
Choose one: Male Female Other

Is your pet #1 spayed/neutered?
Choose one: Yes No Unknown

Please list the name and species (dog, cat, fish, etc.) of your pet #2

Please list the age, weight, breed and personality of your pet #2

Gender of your pet #2
Choose one: Male Female Other

Is your pet #2 spayed/neutered?
Choose one: Yes No Unknown

Please list the name and species (dog, cat, fish, etc.) of your pet #3

Please list the age, weight, breed and personality of your pet #3

Gender of your pet #3
Choose one: Male Female Other

Is your pet #3 spayed/neutered?
Choose one: Yes No Unknown

If you have 4 or more pets, please enter additional pet information here.

What has happened to the pets you have owned in the past 5 years? (re-homed, surrendered to shelter or rescue group, euthanized, died of natural causes, ran away, got lost, killed by outside force, etc.) Please list all.*

Are all of your pets current with appropriate vaccinations?*
Choose one: Yes No Unknown

Are all of your pets current on heartworm prevention?*
Choose one: Yes No Unknown

Are all of your pets current on flea/tick prevention?*
Choose one: Yes No Unknown

If any of your pets are not spayed or neutered, or are not current on vaccinations, heartworm preventative, or flea/tick preventative, please explain here.

Family Veterinarian and Personal References:  By completing this section, I am authorizing The Street Dog Project or any of their partner rescues to inquire about the health status of my current animals as well as any deceased/no-longer-owned animals on their records under my/our name.  I am authorizing release of shot records, heartworm preventative purchase(s) and whether or not the animal visited a clinic in the last 12 months.

*NOTE:  It is possible that an applicant has not had pets and therefore does not have a veterinarian.

Where do you currently take your pet(s) for vetting? Clinic name or Veterinarian name.

Veterinarian/Clinic phone

Veterinarian/Clinic Address

Personal Reference 1 Name*

What is your relationship with Personal Reference 1?*

Phone number for Personal Reference 1*

Personal Reference 2 Name*

What is your relationship with Personal Reference 2?*

Phone number for Personal Reference 2*

Is there anything else that you would like us to know? Please use this space for additional comments, additional veterinarian information, or additional information about another question.

PLEASE READ THE FOLLOWING CAREFULLY.

I hereby certify that the information provided in this form is true. I understand that any falsification discovered may result in the nullification of this adoption.

I understand that this dog may live 15 or more years and I am prepared to give him/her the medical and emotional care and support that he/she needs. In addition, I understand that dog expenses (i.e. food, medical care, vaccinations, licensing, training, and supplies) may average $1,200 or more annually. 

Adoptions are based on best match, thus this application may not necessarily result in the adoption of the animal(s) listed above. Please know that The Street Dog Project strives to achieve the most successful match for both dog and prospective family. I understand that The Street Dog Project rescue representative may perform reference checks and visit my home for a home inspection before my adoption application is approved.

BY AGREEING BELOW, I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, ANSWERED ALL QUESTIONS TRUTHFULLY, AND HAVE A FULL UNDERSTANDING OF THE RESPONSIBILITIES OF ADOPTING A PET. 

I make this statement under penalty of perjury under the laws of the state of Texas.

Please check one.*