|
|
For Office use only:
Date Recd___________________ Adoption Approval
Rep__________________________
H.V. Date__________ Approved____Yes ____No Approved w/
Conditions___Yes ___No
Dal-Savers Dalmatian Rescue, Inc.
P.O. Box 090151
Milwaukee, WI 53209-0151
Voice Mail & Fax 414-297-9210
E-Mail: LoveAdal@yahoo.com
Web Site: http://dalrescue.us
Tell us why you want to own a Dalmatian
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
If no, what have you done to research the
breed?_______________________________________________________________________
___________________________________________________________________________
TYPE OF DALMATIAN YOU'RE LOOKING FOR
(The more flexible you can be, the shorter the wait could be.)
SEX ___Male ___Female ___No Preference
COLOR ___Black Spots ___Liver Spots ___No Preference
AGE RANGE ___Up to 1yr ___1yr-3 ___3yrs-5
___5yrs-7 ___7yrs or up ___No Preference
How long are you willing to wait for the best
match?______Months
PERSONAL INFORMATION
Primary Adopter_________________________ Secondary
Adopter______________________
Address________________________________
City_________________________________
State_________________________ Zip_____________ Home
Phone(___)_______________
Primary Adopter Occupation____________________ Work
Phone(___)__________________
Secondary Adopter Occupation __________________ Work
Phone(___)__________________
Primary Adopter Email Address_____________________
Secondary Adopter Email Address___________________
How long at present address________ Do you ___own ___rent
If you rent, landlord name___________________________
Phone(___)________________
Do you live in a/an ___Apartment ___House ___Condo ___Townhouse
How many people reside in your home? _________Adults
_________Children
Ages of children
______________________________________________________________
Does anyone in your home have allergies? ___Yes ___No If yes,
who______________________
If you move in the future, what will you do with your dog?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
HOME ENVIRONMENT
Do you have a COMPLETELY fenced in yard? ___Yes ___No
If Yes: Height of Fence______________________ Type of
Fence________________________
If no or if not completely fenced in, how will you contain your
dog to your property? (Be specific)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Primary Adopter Work Hours
____________________________________________________
Secondary Adopter Work
Hours__________________________________________________
How many hours per day do you expect the dog to be left alone?
_________________________
Where will you keep the dog when no one is home?
_________________________
Where will you keep the dog during the night when you are
sleeping? _________________________
What will you do with the dog if you need to travel for personal
business reasons?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
PET EXPERIENCE
List current animals you own:
| Type/Breed | Age | Dominant or Submissive |
Sex Female/Male |
Neutered/Spayed/ Intact |
Behavior with other dogs |
Any behavior issues with this dog |
|---|---|---|---|---|---|---|
| __________ | ___ | ___________ | ___________ | _______________ | ___________ | _____________ |
| __________ | ___ | ___________ | ___________ | _______________ | ___________ | _____________ |
| __________ | ___ | ___________ | ___________ | _______________ | ___________ | _____________ |
Current veterinarian: Name
______________________________________________________
City______________________ State_________________
Phone(___)___________________
If you do not currently own a dog, have you owned one before in
your adult life? ___Yes ___No
If Yes:
| Type/Breed | Neutered/Spayed/ Intact |
What happened to him/her? | Name & phone of veterinarian who last saw this pet |
|---|---|---|---|
| __________ | ________________ | _______________________ | ___________________________ |
| __________ | ________________ | _______________________ | ___________________________ |
| __________ | ________________ | _______________________ | ___________________________ |
Are you willing to obtain a crate/kennel and crate train the
dog if necessary? ___Yes ___No
Are you willing to enroll the dog in obedience training classes?
___Yes ___No
If yes, name of facility if you have one picked out:
_____________________________________
If no, what are your plans for training the dog: (Be specific)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
How do you plan on exercising the dog?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
If you have never owned a dog in your adult life, please list two
References:
Name: ___________________ Phone #: ________________ Relationship:
________________
Name: ___________________ Phone #: ________________ Relationship:
________________
MISCELLANEOUS
Rescued animals need time to adjust to a new home. Are you
willing to give this dog adequate time to adjust to ensure proper
adjustment - at least three weeks in some cases? ___Yes ___No
If no, how long do you feel is a fair amount of time to adjust?
_____________________________
What would be unacceptable behavior in your home for you to want
to give up the dog?
__________________________________________________________________________
__________________________________________________________________________
How did you hear about Dal-Savers? (Please check all that apply)
___Internet ___Family/Friend ___Word of Mouth ___Newspaper Ad ___Vet's Office ___Groomer/Trainer ___Flyer Posted at local pet store ___Other________________________________
Are you willing to have a Dal-Savers representative visit your
home by appointment prior to adoption? ___Yes ___No
If no, reason:
__________________________________________________________________________
I understand that in order to complete processing of this
application, a visit to my home is required. This will be
scheduled by a representative of the Dal-Savers Organization and
that by submitting this application, I agree to such a scheduled
visit. I/We acknowledge that all the information contained on
this form is true and correct. I/We understand that any
misrepresentation of fact may result in removal of the adopted
dog from my home by Dal-Savers Dalmatian Rescue, Inc.
_______________________________________________ ___________________ Primary Adopter's Signature Date _______________________________________________ ___________________ Secondary Adopter's Signature Date
