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Adoption Application

Any Questions? Please call us at (302) 650-1710 or (610) 848 0369 or email at tristateshepherdrescue@gmail.com

Contact and Personal Information

Name:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

E-Mail:

Dog Interest

Do you know about the $350 Adoption Fee?

YesNo

Which dog you are interested in adopting?

Employment Information

Employer’s name/number:

Spouse’s Employer/number:

General Information

Do you live with ?

Spouse/PartnerRoommate(s)ParentsChildrenAlone

How old are you?

Your Spouse?

Others including children in the house:

Does every individual in your home know that you are adopting?
YesNo

Do any individuals in your home have allergies to animals?
YesNo

How often have you moved in the past 5 yrs?

References: Please provide the name and contact of three references not related to you who can attest to your character.

Name:

Contact:

Name:

Contact:

Name:

Contact:

Please provide name and contact info for all vets in the last ten years. Please give them permission to speak with us.

Dog’s living situation (check all that apply):

house pet, living inside with familylive in basement or garagelive outdoors

How many hours per day will dog be home alone?

Will the dog be crated inside when alone?

YesNo

Will the dog be crated inside or an outdoor kennel? If so for how long and when?

Crated InsideOutdoor KennelNeither

Please describe:

Will the dog be kept outside in any form? If, how long and when?

YesNo

Please describe:

What kind of exercise will the dog have? Fenced yard, leash walks, etc. Please describe:

Home Information

Is the home Urban, Suburban, Townhouse, Rural?

Yard size is:

Is the yard enclosed by a fence?

YesNo

If Yes:

Height:

Length:

Type of Fencing:

If you are renting, please provide Landlord’s name and phone number for verification:

Landlord Name:

Landlord Phone:

PREFERENCES – WHAT ARE YOU LOOKING FOR?

Please list preferences:

Age:

Sex:
MaleFemale

SIZE :

PUREBRED OR MIX:

ENERGY LEVEL - are you a marathoner or a couch potato?

OTHER PETS CURRENT AND PRIOR EXPERIENCE

Please list pets you have currently or have had in the last three years:

NAME:

BREED:

ALTERED :
YesNo

AGE:

UP TO DATE ON VACCINES?:
YesNo

WHERE IS PET CURRENTLY? :

NAME:

BREED:

ALTERED :
YesNo

AGE:

UP TO DATE ON VACCINES?:
YesNo

WHERE IS PET CURRENTLY? :

NAME:

BREED:

ALTERED :
YesNo

AGE:

UP TO DATE ON VACCINES?:
YesNo

WHERE IS PET CURRENTLY? :

NAME:

BREED:

ALTERED :
YesNo

AGE:

UP TO DATE ON VACCINES?:
YesNo

WHERE IS PET CURRENTLY? :

Have you ever been convicted of animal cruelty, dog fighting, or other crime relating to animals? YesNo

If yes, explain

Have you ever had to give up a Pet for any reason? YesNo

If yes, explain

By submitting this form I certify that the answers in the above Adoption Application are true. I understand that if falsifications exist in this application the adoption process will be terminated.

Additional Information or Comments:

Note: Once you submit the application here you will sign the form electronically on the bottom of the next page

Contact Us

108 East 29th Street
Wilmington, DE 19803

tristateshepherdrescue@gmail.com

(302) 650-1710

302-291-3339

Tri State Shepherd Rescue

Email Address

Mailing List

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