Adoption Application (Old) Question Title * 1. What is your full name? Question Title * 2. Are you 21 years or older? Yes No Question Title * 3. Driver's License Number Question Title * 4. Name of Employer or School Question Title * 5. Length of Current Employment Question Title * 6. What is your address? Please include City Question Title * 7. Please list all of the phone numbers we can reach you at Question Title * 8. What is your email address? Question Title * 9. How many people currently live in the house (full or part-time) and what are their ages? Adults Children Question Title * 10. What is your current living condition? Own Home Rent Home Rent Apartment Rent Condo Own Condo Other (please specify) Question Title * 11. If you rent, please include your landlord's name, address, phone number, and email Question Title * 12. Does your landlord allow pets? Yes No Question Title * 13. If your landlord allows pets, are there any restrictions? Question Title * 14. How long have you been at your current address? Question Title * 15. If you've been at your address for less than 2 years, please list previous addresses in the last 2 years Question Title * 16. Do you have a fenced in yard? Yes No Question Title * 17. If you have a fenced yard, how tall is it, what type, and is it locked? Question Title * 18. Do you plan on moving in the near future? Yes No Question Title * 19. If you plan on moving, where will you move to? Question Title * 20. DOG ONLY: Which specific dog are you interested in? Question Title * 21. DOG ONLY: What types of dog are you interested in? Friendly Physically Challenged Working Breed Senior Puppy High Energy Shy or Timid Requires training Special Medical Needs Other (please specify) Question Title * 22. DOG ONLY: What is your desired level of activity with the dog(s)? Backyard Long Walks Intense training/tricks Short Walks Hiking/jogging Dog Park None Other (please specify) Question Title * 23. DOG ONLY: What are your preferences in a dog? Male Female Short Hair Long Hair Hypo-allergenic Other (please specify) Question Title * 24. DOG ONLY: Desired Age range Question Title * 25. DOG ONLY: Desired Breed(s) Question Title * 26. DOG ONLY: Desired weight/size Question Title * 27. DOG ONLY: When left alone inside the home, how will the dog be kept? Crate In a room free to roam Other (please specify) Question Title * 28. Will your dog be left outside unsupervised? Yes No Question Title * 29. DOG ONLY: If left alone outside of the home, how will your dog be kept? In garage Tie out chain Confined to patio area fenced yard loose in yard Other (please specify) Question Title * 30. DOG ONLY:How do you plan to introduce your dog to other pets in the home? Question Title * 31. DOG ONLY: If the following issues occur, please describe how you would handle them. Jumping Getting on Furniture Chewing on things Shedding Barking/Howling Digging Chasing Cats Food Bowl Aggression Begging Doesn't play Question Title * 32. DOG ONLY: If the following were to occur, which would you get rid of your dog over? Doesn't play Begging Food bowl aggression Chasing Cats Digging Barking/Howling Shedding Chewing on things Getting on furniture Jumping Other (please specify) Question Title * 33. CATS ONLY: Which specific cat are you interested in? Question Title * 34. CATS ONLY: What types of cats are you interested in? Friendly Physically Challenged Independent Senior Cuddly Shy or Timid High energy kitten Special Medical Needs Lazy Feral Other (please specify) Question Title * 35. CATS ONLY: Click on all that you prefer about your cat. Male female short hair long hair hypo-allergenic Other (please specify) Question Title * 36. Will you cat be inside or outside? If both, please say how much time your cat will spend outside. Inside Outside Both Question Title * 37. CATS ONLY: Please describe how you would handle the following issues if they were to occur Getting on Furniture Scratching Things Shedding Being noisy Digging Chasing/ killing other animals Doesn't play Question Title * 38. CATS ONLY: Which issue would be a reason you would get rid of your cat for? Chasing/killing other animals Digging Being Noisy Spraying Jumping Shedding Scratching things Other (please specify) Question Title * 39. May we contact your vet? Yes No Question Title * 40. Please give your vet's name, address, and phone number Question Title * 41. Are your pets spayed or neutered? Yes No Question Title * 42. Are your dogs licensed? Yes No Question Title * 43. Are your animals current on vaccines? Yes No Question Title * 44. Please list all animals in the household, their breed, age, gender, temperament, and medical status: Question Title * 45. Please tell us about your previous animal experience Question Title * 46. Please list the name and phone number for two people who can give a character reference preferably relaated to your animal experience. Ex: Long term friend, co-worker, minister Reference 1 Reference 2 Question Title * 47. Have you ever taken an animal to the pound? If yes, please explain why. Yes No Other (please specify) Question Title * 48. If you are no longer able to care for the adopted animal, do you agree to notify Second Chance Dog Rescue as soon as possible? Yes No Question Title * 49. The above Statements are true to the best of my knowledge Yes No Submit