Adoption application Adoption Application Adoption Application for Rosco P. Coal Train Community Outreach * Name of dog you are interested in * Your First and Last Name * Your Significant Other's First & Last Name * Address * City, State, Zip * How long have you lived at that address? * Do you plan to move in the next couple of years? Yes No Not sure * Home phone (area code first) * Cell phone (area code first) * Email address: * Number of adults in the household * Children in the household (and ages); if 0 please type "None" * Current veterinarian name (or planned vet if this is your first pet) * Veterinarian phone * If with this vet for less than 2 years, give contact information for your previous vet * Do you currently have pets? Please list type, name, breed and age * If they are dogs or cats, are they spayed or neutered (fixed)? * If they are dogs or cats, are they current on vaccinations and pest preventatives? * Have you lost a dog to accident, old age or disease? Please describe the last 2 * Have you adopted from a rescue before? If so, please provide the name of the organization and the contact you dealt with * Personal reference of a non-relative who has a dog that you've interacted with (include name, phone, how you know that person and for how long you've known them) * Do you live in a.... House (does it have a fence?) Apartment/condo Other * Do you own the property? If no, please provide name and contact information for your landlord * What kind of area do you live in? Rural Suburban Urban * Distance to the closest heavily traveled road * Property size * Yard size * Fencing? (Please describe) * Outdoor shelter/shade? * Doggie door access * How many hours a day are you away from the house (working, shopping, etc.)? * Where will the dog stay when you are not at home? * How flexible is your schedule if the dog needs veterinary care? * How long have you worked for your current employer? * Where will the dog stay when you go on vacation or leave town for other reasons? * What type of vehicle will be used to transport the dog to the vet and other places? * Where and how will the dog ride in the car? (crated, seat belted, leashed, loose, etc.) * Do you understand the dangers of a dog in a parked vehicle, bed of a pickup or hanging its head out the window? * Describe your familiarity with the breed you are wishing to adopt * Are you open to taking positive reinforcement dog training classes? * Will you immediately seek experienced help if behavior problems arise that you are unsure how to correct in a positive manner? Do you understand that if approved, when you sign the adoption contract you are agreeing to never abuse or neglect the dog, and to never give up the dog to anyone without first contacting this rescue for permission? Yes No Additional comments
