Karma Rescue - Dog Adoption Application

Please fill out this form completely; failure to answer one or more questions may result in your application being rejected. Completion of this application does not guarantee adoption of a Karma Rescue dog.

Name of desired dog:
Your name:
Your occupation:
Spouses name:
Spouses occupation:
Name/ages of children:
Other occupants in home:
Home address:
City:
State/province:
Zip/postal code:
Home phone:
Mobile phone:
E-mail address: (valid email is required)
Your age:	Age 18-21 Age 22-26 Age 27-32 Age 33-45 Age 46-55 Age 55-70 Age 71+
Type of dwelling:	House Condo Apartment Other
Do you personally rent or own?	Rent Own
If renting, do you have landlords permission to have a dog?	Yes No
Is there a size/weight limitation? What is it?
Landlord’s name and phone number:
How long have you resided at this location?
Primary reason for wanting a dog:	Companion for You For Kids For Other Pet Watchdog Other
If other, please specify:
If you have children, please describe their previous experience with dogs:
If your children did not want a dog, would you be interested in adopting one for yourself?	Yes No
Does anyone in your household have allergies? If yes, describe:
Do you have a pet now? How many?
List type of pets (if dog, list breed); age(s) and sex(es):
How long owned?
Where did you get your current pets?
Do your animals have any physical issues?
Do your animals have any behavioral issues?
Do your animals get along with (other) dogs?
Have you ever had multiple dogs in your home?	Yes No
How did you feed them?	Next to Each Other In Same Room Separated Free Feed Other
Did you have toys and/or bones around?	Yes No
Are your pets spayed/neutered?	Yes No
Have you ever allowed an animal to breed?	Yes No
Have you ever had to surrender an animal to a shelter or rescue group?	Yes No
If yes, please explain:
Is there anybody home during the day? Who?
When will the dog be inside? Outside?
About how many hours will the dog be left alone?
Where will the dog stay when he/she is home alone? (please be as specific as possible; i.e. run of the house, a specific room, a crate, etc.)
Where will the dog sleep at night? Doghouse, garage?
If inside, where exactly? Kitchen, master bedroom, spare room, laundry room, run of the house, other?
If other or if you have additional comments on where the dog will sleep, please specify:
What rooms are off limits to the dog?
What outside areas are available to the dog? (Select all that apply)	Fenced Yard Enclosed Patio Garage Doghouse Unfenced Common Area Other
If other, please specify:
Do you have a doggie door?	Yes No
Type of fencing? (Chain link, wood, block wall, etc.)
Height of fence? List highest point and lowest point:
I have recently inspected my fences and they are good condition:	Yes No
The fence is intact on all sides and is at least 6 feet from the ground level in all areas:	Yes No
I promise to inspect my fences thoroughly before the home visit and make necessary repairs for the safety and well being of our new Pet:	Yes No
Are there gates?	Yes No
How many gates?
How high?
Is there any type of lock on the gate(s)?	Yes No
Type of lock: (padlock, key, latch, etc.)
If no locks, would you be willing to install them prior to placement should this application be accepted?	Yes No
Do you have a swimming pool?	Yes No
If yes, is swimming pool surrounded by a gate?	Yes No
Who has access to your yard? (Select all that apply)	Immediate Family Only Gardener Pool Man Utility Neighbor Other
If other, please explain:
Preferred level of exercise with dog:	Couch Potato Short Walks Vigorous Walks Hike or Jog Regularly Dog Park Other
How would you socialize your dog?	Dog Park Doggy Day Care Play Dates with Other Dogs Other Dogs At Home
When you go on vacation, who will care for the dog? (friend, kennel, dog-sitter, etc.)
Are you moving or traveling in the next 12 months? Please explain:
What kind of food will you feed the dog? Brand of kibble, canned, other:
Do you have a regular vet?	Yes No
Name of vet:
Would you like a referral to a vet?	Yes No
Who will groom and bathe your dog?
Would your dog wear a collar?	Yes No
When?
Would you allow your dog to wear a permanent Karma Rescue I.D. tag?	Yes No
How would you rate your level of dog owning experience?	First Time Owner Beginner Intermediate Advanced Other
If other, please explain:
How would you train this dog?	Obedience Class Hit with Newspaper Firm Verbal Commands Clicker/Hand Signals Other
If other, please explain:
How would you discipline your dog, if at all, if he or she misbehaved?
What, if any, behavioral issues have you dealt with in the past?	Dog Aggression People Aggression Leash Aggression House Breaking Separation Anxiety Escaping Fear Aggression
Have you ever had any of your own dogs get into a fight?	Yes No
If yes, please explain
Would you “Crate and Rotate” your dogs (live separated) if they did not get along down the line?	Yes No
Would you be able to live with your dogs where you had to limit your affection?	Yes No
Would you bring in a trainer that can cost anywhere from $300 up to $1500 or more that deals with dog aggression?	Yes No
Would you be willing to sign your new dog up for obedience classes at your own expense?	Yes No
How do you normally walk your dog? On leash, off leash	On Leash Off Leash
When on leash do you normally use:	Collar Only Corrective Collar Harness Other
If other, please specify:
If your dog escaped from your home, what steps would you take to find him/her?
Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times?	Yes No
Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new pet?	Yes No
Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as much as 10 to 20 years?	Yes No
What would happen to your pets if you moved locally?
Out of state?
Out of the country?
Which of the following reasons might prompt you to give up your dog? (Select all that apply)	Excessive Barking Biting Digging Moving Divorce Baby Illness Not Getting Along With Other Pet Poor Watchdog Destructive Chewing Financial Problems Occasional Accidents Indoors Growling at Guests Excessive Vet Bills Shedding Allergies New Spouse/Partner Does Not Like Dogs Aggressive on Leash None of The Above
Comments:
If your present relationship was to change or there was a death in the family, with whom will the dog go to?
Please list pets you have owned since you have been an adult and the length of ownership; if they are no longer with you, please provide an explanation (died, gave away, etc): (please list type (breed/breed mix))
How did you find out about our adoption program?
Why are you interested in adopting from a rescue?
Please read and check each statement below
I understand that a home visit is required prior to final placement:	I understand that a home visit does not guarantee placement:
Yes	Yes
I CAN give a tax-deductible charitable adoption contribution of at least $300 to help rescue, provide medical care, spay, and neuter, board and place other abandoned dogs. (Inability to make an adoption donation does not disqualify an applicant from consideration). I understand that this adoption donation or contribution is a gift freely given, not a purchase price for a dog:	Yes No
I agree to provide my own collar, leash, corrective collar or harness, and a personal ID tag at the time of completing the adoption contract:	Karma Rescue reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract:
Yes	I understand
Please list the name of the dog you're interested in again, and tell us why you're interested in this particular dog: