First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Text/Pager Email

Which animal are you interested in
Choose an animal: Autumn Daisy Baxter B Brody aka Rudy China Dude Fox Gibbs Hannah Hazel Jakee Kash Lila Rose Logann Mojo Nacho Cheese Ruthie Silver Stellaa Rose Stormi Weather Syah Thunder Chap

Employer

Why do you want this pet? *

I understand and agree that a representative for TDR will come to my home for a visit PRIOR to any adoption.*

I am at least 18 years old?*

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, have you received the approval of your landlord to have an animal
Choose one: Yes No

I give my permission for a representative of Tired Dog Rescue to call my landlord if I rent.

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

Is your yard fenced

What type of fence
Choose one: Privacy Chain Link Invisible

Are you planning to move in the next 6 months?*

Are there children living in the household?*

What are the ages of ALL persons living in the home?*

Does anyone in the household have animal allergies?*

Have you owned a pet in the past? If yes where are those pets now? Were previous pets spayed/neutered?*

Have you ever surrendered an animal to the shelter?*

Why did you surrender?

Please list all pets in the home currently along with their age/breed. Are your current pets spayed/neutered?

Do you give your pets heartworm prevention consistently? *

What brand of heartworm prevention do you use?

I understand and agree that a representative from Tired Dog Rescue WILL CALL my vet(s) to acess my current and past pet's medical history. I agree to call my vet in advance and give permission for a Tired Dog Rescue to obtain my pets records pertaining to spay/neuter, shots, and Heartworm prevention. *

Please list the name the pet is listed under at your vet and whether the owner is you or relative or married name. For example. Is the dog under Buffy Smith or Buffy Evans. If no pets write N/A *

List ALL VET CLINICS that you have used in the past or are currently using PLEASE INCLUDE PHONE NUMBERS. SPECIFICALLY the vet's who have done vaccinations and prescribed heartworm medicine. If no pets please write N/A *

I understand that I may be asked for proof of vaccinations, heartworm prevention and spay/neuter if discrepancy with vet reference.*

When you are out of town what will you do with your pets?*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

How do you plan on exercising your dog? *

Describe how you will train the pet

What behaviors would you be unwilling to work with. *

What reasons might cause you to return this pet?*

I understand there is a fee that can range from 75.00-450.00?*

I can afford veterinary care, grooming, emergency expenses, supplies and food for the lifetime of this pet.*

I understand and agree that the current rescue makes no guarantees about the animals temperament and is not responsible for future damages or injuries cause by the animal. "TDR will provide guidance on any known behavioral issues upon receiving an animal for fostering. However, TDR does not guarantee the behavior of current or future fosters. The foster agrees to hold TDR harmless in case of adverse behavioral issues with any current or future animals." *

Tired Dog Rescue considers all their dogs as part of their family. Would you be willing to update us on the dog that you adopt and send pics occasionally? *

I understand that TDR reserves the right to refuse the adoption of any animal*

All statements on this form are true to the best of my knowledge*

Write any additional comments you might have.