APPLICATION
TO ADOPT A DOG or PUPPY
Wichita, KS 67201
APPLICATION
TO ADOPT A DOG or PUPPY
Instructions:
Please
read this application, fill in the blanks, sign it, and return it to K-9 ResQ.
Attach an additional sheet if more room is needed.
The information you provide in this application and during our interview
will help us find a good match for you and insure a responsible home for our
rescued dogs.
Name
Spouse/Roommate
Address
City
State
Zip
Home
Phone
Occupation
Hours
Age:
Over 21?
Yes
No
E-Mail Address
List
three references including your veterinarian:
Name
Phone
Relationship
Describe
the kind of dog you are interested in adopting:
Age
Sex
Reason for sex
preference
Breed
/ mix
Size
Coloring
Temperament
Other preferences
Why
do you want a dog?
Why
do you like the breed / mix you are interested in?
Have you
owned this breed/mix before?
Will
you commit to care for the dog for its whole life?
Provide
the following information about your pets, your children and your home:
How many dogs or cats do you presently own? Dogs Cats Please list:
Dog
or cat
Breed / mix
Sex Age
Spayed/neut? Where
obtained?
1.
2.
3.
Are all of the above dogs given monthly heartworm prevention from your veterinarian? Yes No
Have all the above pets been given the recommended annual vaccinations each year? Yes No
Where
are the above pets kept during the day?
Indoors
Outdoors
Both
Where
are the above pets kept at night?
Indoors
Outdoors
Both
Your
previous pets:
Have you owned dogs or cats in the past? Yes No If yes, please list:
Dog
or cat
Breed / mix
Sex Age
Spayed/neut?
Describe what happened to pet.
1.
2.
3.
Your children:
Do you have children? Ages Have they had dogs?
Describe any problems
Your home:
Number
of adults
Do you own or rent
your home? If renting, do you have permission from your landlord to
have a dog? Landlord’s
name
Phone
Is your home an Apartment Duplex Townhouse Single house Mobile home Other
Yard size
Is the yard fenced?
Type of fence
Height
Any
community restrictions on dogs?
How will your new dog spend its days?
(Circle everything that
applies)
Indoors Your bedroom Kitchen Crated Basement Garage Porch Confined to one room
Fenced
yard Tied
outside Loose
unfenced Dog house
Kennel run Other
How will your new dog spend its nights? (Circle everything that applies)
Indoors Your bedroom Kitchen Crated Basement Garage Porch Confined to one room
Fenced
yard Tied
outside Loose
unfenced Dog house
Kennel run Other
Our application process includes a home visit and contacting the references you provide especially your veterinarian. Your application will be reviewed by a committee of K-9 ResQ volunteers who will determine whether or not you are approved. You will be contacted of their decision.
Before
you may adopt a dog from K-9 ResQ, you must agree that if you are ever unable to
keep the adopted dog, it must be returned to a K-9 ResQ volunteer and you will
be given a full refund of your adoption fee.
The
adoption fee is $95 for a spayed/neutered, vaccinated and heartworm negative
dog.
Application information. All of the information I/we provided in this application is true and correct. If any of the information changes, I/we will advise you promptly.
Date:
Signature
Volunteer Spouse / Roommate Signature