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Adoption Application
Step 1 of 4 - Basic
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Which animal are you interested in adopting?
Name
*
First
Last
Age
*
Occupation
*
Email
*
Main Phone
*
Secondary/Cell Phone
*
Work Phone
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Adults in household
How many other adults (over 18) live in your household?
*
0
1
2
3
4
5
More than 5
1st Adult's Name
*
First
Last
1st Adult's Relationship
*
Spouse
Domestic Partner
Parent/Grandparent
Son/Daughter
Niece/Nephew
Other Relation
Roommate
1st Adult's Age
*
18-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
65+
2nd Adult's Name
*
First
Last
2nd Adult's Relationship
*
Spouse
Domestic Partner
Parent/Grandparent
Son/Daughter
Niece/Nephew
Other Relation
Roommate
2nd Adult's Age
*
18-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
65+
3rd Adult's Name
*
First
Last
3rd Adult's Relationship
*
Spouse
Domestic Partner
Parent/Grandparent
Son/Daughter
Niece/Nephew
Other Relation
Roommate
3rd Adult's Age
*
18-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
65+
4th Adult's Name
*
First
Last
4th Adult's Relationship
*
Spouse
Domestic Partner
Parent/Grandparent
Son/Daughter
Niece/Nephew
Other Relation
Roommate
4th Adult's Age
*
18-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
65+
5th Adult's Name
*
First
Last
5th Adult's Relationship
*
Spouse
Domestic Partner
Parent/Grandparent
Son/Daughter
Niece/Nephew
Other Relation
Roommate
5th Adult's Age
*
18-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
65+
Names, ages and relationships of all additional adults in household.
*
Children in household
How many children (under 18) are in your household?
*
0
1
2
3
4
5
5+
1st Child's Name
*
First
Last
1st Child's Relationship
*
Son/Daughter
Niece/Nephew
Other Relation
Not Related
1st Child's Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
2nd Child's Name
*
First
Last
2nd Child's Relationship
*
Son/Daughter
Niece/Nephew
Other Relation
Not Related
2nd Child's Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
3rd Child's Name
*
First
Last
3rd Child's Relationship
*
Son/Daughter
Niece/Nephew
Other Relation
Not Related
3rd Child's Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
4th Child's Name
*
First
Last
4th Child's Relationship
*
Son/Daughter
Niece/Nephew
Other Relation
Not Related
4th Child's Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
5th Child's Name
*
First
Last
5th Child's Relationship
*
Son/Daughter
Niece/Nephew
Other Relation
Not Related
5th Child's Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Names, ages and relationships of all additional children in household.
*
Current Pets
How many pets do you have now?
Dogs
*
Cats
*
Other
*
Are your current pets vaccines up-to-date?
*
Yes
No
Don't know
Are they all spayed and neutered?
*
Yes
No
Don't know
Current veterinarian's name?
*
Vet's Phone
*
May we contact them to ask about your current pets?
*
Yes
No
Have you ever had to relinquish an animal to a shelter?
*
Yes
No
What were the circumstances?
*
Please tell us a little bit about your previous pets and anything else you would like us to know about your current pets.
Residential Info
If your application is approved will you consent to a home check?
*
Yes
No
Do you live in a ...?
*
House
Apartment
Condo
Do you ...?
*
Rent
Own
Live with family
Live with friends
Your Landlord's name
*
Landlord's Phone
*
Does your home have a fenced yard?
*
Yes
No
Does your residence have a doggie door?
*
Yes
No
Does your landlord allow pets?
*
Yes
No
Not sure
Does your landlord have size restrictions?
*
Yes
No
Not sure
Why are you planning to adopt a dog? (check all that apply)
*
For a companion
For yourself
As a gift
For hunting
For your family
Buddy for another pet
Running partner
As a guard dog
Bark at strangers
What qualities are you looking for in a new dog?
*
Please list any concerns you have about your new pet, or any questions you may have for us.
Do you have experience training dogs for any of the following?
Obedience
Housebreaking
Agility
How will you deal with destructive behavior like chewing, digging, or jumping?
*
What will you do if your new dog bites or snaps at a family member?
*
Who will have the primary responsibility for the following:
Feeding
*
Obedience
*
Vet Care
*
Exercise
*
Routine health care can cost up to $300.00 a year and emergencies are often over $1,000. Are you willing to provide this care if necessary ?
*
Yes
No
Where will your new pet be kept...
At night?
*
If you move?
*
During the day?
*
While on vacation?
*
On an average day how long will the pet be left alone?
*
How many days per week?
*
What will you do with your new dog if you can no longer keep it?
*
I understand that Cold Wet Noses cannot and does not make any representation of warranties, either expressed or implied concerning the temperament, habit, health, pedigree, disposition, sex, or background of this animal and that I have no rights to reimbursement of medical or professional fees. Furthermore, I understand that the animals' future reactions to me, my family, or any other persons are completely unpredictable because animals can have their own personalities. I also assume full responsibility to provide proper food, water, shelter, veterinary care, exercises, and a safe environment for this animal. I agree to never leave my animals unattended in a motor vehicle at any time.
In consideration of receiving this animal the adopting party hereby releases Cold Wet Noses, it's foster parents, and any employees from claims of liability to anyone for injuries or damage caused to them or their property.
By typing my initials below I agree that if I cannot keep the pet I am adopting for its lifetime, that I will not euthanize or give the animal to anyone, including friends, relatives or another shelter prior to contacting TCWN. I agree to return the animal upon request but understand that TCWN is not obligated to take the pet.
Initials
*
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