Application for Act of Love Rescue Dog Adoption

Please apply to adopt a dog from Act of Love using the form below. Do not leave any fields blank, use N/A, if no pertinent information. Otherwise, your application may not submit properly.

Which dog are you interested in? (required)

Are you interested in adopting?
Adopting
Would like approval for the future

If the dog of your choice is not available, would you be interested in adopting another dog? (Please be honest)
I would be interested in adopting another dogI would be interested in proceeding with approval for the futureI would not be interested in adopting another dog

How did you hear about our rescue group?

Personal Information

First Name

Last Name

Street Address

Address Line 2

City

State
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific

Zip Code

Email Address

Your Cell Phone Number

Alternate Phone

Best time to call

Employment

Employment of others in the Household

Veterinarian Information

(If you currently have a pet, vet information below is required! Also please advise your Vet's office to expect a call from one of our representatives and to release any information requested.)

Your Vet's Name

Street Address

Address Line 2

City

State / Province / Region
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific

Zip Code / Postal

Your Vet's Phone Number

Personal References. Please provide the name, phone number and email address of TWO personal references we may contact (Neighbor, friend, co-worker).

Residence
Own Home
Rent Home
Own Apartment
Rent Apartment
Other
Please choose your type of residence.

If you chose other types of residence above. Please explain.

How long have you resided here?

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

We request this information so that we can verify you are permitted to have a pet.

Please list all people who currently live at this residence (including yourself). (Include name, age, and relationship to you)

Who will be responsible for the care of your new dog?

Please list all pets who CURRENTLY live in your household. (Include NAME, TYPE/BREED, AGE, GENDER, ALTERATION STATUS, HOW LONG OWNED, INDOOR OR OUTDOOR, CATS DECLAWED.)

Please list any pets you have owned in the past. (Include NAME, TYPE/BREED, AGE, HOW LONG OWNED, WHAT HAPPENED TO PET.)

Have you ever taken one of your pets to a shelter or given an animal away? Please explain the circumstances.

How do you plan to have your dog relieve itself?

What type of exercise and activities do you plan to do with your dog?

How many hours each day will your new dog be alone?

Do you work full-time or are gone more than 4-5 hours at a time. What is your plan for the dog whilst away?

Where will your new dog be kept when you are not home?

Where will your new dog be kept when you are home?

Where will your new dog sleep?

What types of training methods do you plan to use to train your new dog?

Many shelter dogs need to go through decompression period and have slow introductions to your resident pets. Do you have a way of separating our new dog from your current dogs(or other pets)? If so how?

Who will care for your new dog when you are on vacation?

Would you like a trainer's recommendation?

By checking YES you agree that if you are chosen to adopt the pup, you will review and agree to an adoption contract, which is wholly in the pup's best interests.
Yes
No

By checking YES you agree that if you need to relinquish the animal during its life, you will contact Act of Love Rescue, Inc for its surrender.
Yes
No

By checking YES we have your permission to contact these references.
Yes
No

By checking YES you agree that all pets in your household are spayed and/or neutered.
Yes
No

Adoption Terms

I have read all the above information carefully and have complete this application honestly. I understand that the omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Act of Love reserves the right to annul the adoption and reclaim the animal. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Act of Love volunteer or a courtesy visit through another reputable rescue before an adoption decision is made.

In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is the organization’s prerogative to decide which home is the most appropriate and that their decision is final.

Signature

Today's Date (type in)