Donate to honor Dear friends..

Part I: Your information

  The dog's Name you are interested in adopting?

Have you submitted the application fee and how?Please SelectYes - through PAYPALYes - Mailed Check No                                                             

Please list the name on check or the email account that payment was made through PAYPAL.

If the dog you are applying for is adopted prior to your app being completed and your application is approved, do you wish to go on a waiting list? Please SelectYes No

If yes, please list the breed, sex, and age range that you would be interested in.    

Name
Spouse/significant other
Address
City
State   Zip

Nearest Airport

Day Phone
Eve Phone
Best time to call
Please SelectYesNo Can we call you collect, if it is long distance?

E-mail Address (REQUIRED)

Number of adults in household and ages: Men/ages Women/ages
Occupation of adults in household:

Are you married?Please SelectYesNo

Number of children in household: Boys/ages Girls/ages

Are you agreeable to a home visit as a condition to adopting?Please SelectYesNo

If no, please explain:

Do you or anyone in the home have any allergies?Please SelectYesNo

If yes, have you have discussed with your physician the risk of bringing a dog into the home?   

Please explain and list the type of allergy

Are you expecting a child, or planning a family in the future?Please SelectYesNo

If yes, will this affect any of the living conditions of the animal you want to adopt? 

Please explain:

What type of Dwelling: Apartment/Apartment-Style Condominium Townhouse Duplex/Triplex mobile home House Farm Other

Do you own or rent? Please Selectownrent

If you rent, do you have the landlord's permission to keep a dog? Please SelectYesNo N/A

If yes, please list name and phone number of landlord

How large is your yard?

Is it securely fenced?Please SelectYesNo

If "yes", type of fence, gates, age and height

Can children open the gates? Please SelectYesNo

If the yard is not securely fenced, what type of improvements need to be made so that it is secure?
 

Are you willing to make such improvements? Please SelectYesNo N/A

Do you have a pool? Please SelectYesNo If yes, is it securely fenced? Please SelectYesNo N/A

Do you have a dog run? Please SelectYesNo If yes, is it secure? Please SelectYesNo N/A

Are you aware of any dangers that could harm your dog, inside the yard?

Can strangers gain access to your yard from the street? Please SelectYesNo

Where will dog sleep?

Where will your dog stay when alone? and how long will it be alone?

Do you plan to use a Crate? Why or why not?

Part II: Pet History

Have you ever owned a rescue dog before? Please SelectYesNo

How long?

What happened to him/her?

Where did you get the dog?

Do you have dogs at this time? Name, breed, age and sex? Altered? How long have you had him/her? Temperament?  Please list all current dogs:

Where did you get your current pets?

Any other critters? Ferrets, hamsters, snakes, birds, cats etc? Please SelectYesNo

If yes, please list

Please list all your previous pets, and what happened to them. Please include name, type of pet and how long it was owned.  Also include approximate date of death.

If you have other animals, what have been your main problems with them?

Why do you want a puppy mill dog, as opposed to another pet?

If you have other dogs, would you consider them aggressive or submissive to other people? Please Select Not applicable AggressiveSubmissive

To other animals? Please Select not applicable AggressiveSubmissive

If you have birds, rabbits, cats, rodents etc., are you prepared to spend the necessary time to accustom them and the dog to each other? Please SelectYesNo N/A

Part III: Behavior

What amount of time and effort do you want to devote to training your puppy mill dog?

Are you likely to enroll your dog in obedience class? Please SelectYesNo

Which family members would be expected to assist in home training?

What is your definition of disciplining a dog?

What are your training objectives?

What makes you a good pet owner?

Part IV: What Type of Rescue

Preferences:
Male/Female Please SelectMaleFemale Age

The dogs Name (your First and Second choice dog) from our for adoption pages.  Please list the same name as above.

Would you consider the opposite sex? Please SelectYesNo

Would you be interested in an older dog? Please SelectYesNo

Would you be interested in a young adult? Please SelectYesNo

Generally speaking, what sort of temperament are you looking for in a dog? I.e., playful, quiet…

What amount $ can you donate to rescue your puppy mill dog?  MINIMUM IS $200.00 IN MOST CASE'S. 

Are you aware that some of our rescue dogs have been abused and/or neglected? Please SelectYesNo

Did you read all the information on the website about the Puppy mill dogs ? Please SelectYesNo

Are you agreeable to returning the dog should, due to unforeseen circumstances, you would no longer be able to keep the dog? Please SelectYesNo

Do you realize that dogs can live to be 15 years of age or older, and are you committed to providing responsible care for that long? Please SelectYesNo

Is there anything else that you want to tell us about your family and its suitability to adopt a rescued puppy mill dog?

How did you find out about us?

Have you recently applied for a rescue dog from another organization?  If so, what is the name of the organization and the status of your application with them?

Your comments / suggestions:

Part V: References

Please list three references that can attest to your suitability as a pet owner, and more specifically, the owner of a Puppy mill dog. These references cannot be someone living within the home.  The first reference must be a veterinarian that is familiar with you and your pets.  (If your pets have seen more than one vet, please include their information in Reference #1or #2 and type (ADDITIONAL VET) in the address field:

Vet Reference:
 Name of Veterinary Clinic
 Veterinarian
 Address
 City
 State  Zip

 Hours of Operation
 Phone

Reference #1:
Name
Address
City
State Zip

Day Phone
Eve Phone

Reference #2
Name
Address
City
State Zip

Day Phone
Eve Phone

Please read the following carefully:

I declare that the information I have provided in this application is complete and correct. I further declare that I am financially and physically able to care for a rescued dog, specifically, a puppy mill dog. I understand that proper food and veterinarian care may be costly, and I am able and willing to meet the needs of my adoptive dog. I understand the requirement and grant permission for Home Checks at random both prior to and following adoption. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, PuppymillRescue reserves the right to either refuse adoption or to nullify the adoption and reclaim said puppy mill dog from my premises, without reimbursement of the adoption donation. I release PuppymillRescue from any liabilities I may incur from the adoption process.

Applicant's electronic signature:

Date: 
 

We GREATLY appreciate your taking the time to fill out this form, and appreciate your interest in our dogs.

We will first telephone your vets office.

If they have no record of you then your application will be declined. 

You will hear from us by email or telephone within 2 weeks IF you are being considered to adopt.