Adoption Application

What is the name of the dog, or type of dog, you are interested in adopting?(Required)

Date:(Required)

Example: January 7, 2024

In order to be considered as an adopter you must agree to all

Consent 1(Required)

Be 18 years of age or older (a valid ID may be required)(Required)

Consent 2(Required)

Understand that Valley Dog Rescue has the right to deny your application(Required)

Consent 3(Required)

Have the knowledge and consent of all adults living in your household(Required)

Consent 4(Required)

Have the landlord's consent to bring an animal onto the property(Required)

PART 1 - PERSONAL INFORMATION

Name(Required)

First Last

Age(Required)

Email(Required)

Phone(Required)

Alternate Phone

Street Address(Required)

City(Required)

State(Required)

ZIP Code(Required)

Place of Employment(Required)

PART 2 - ANIMAL INFORMATION

Do you have any other pets?(Required)

Yes

Please list Name, Type, Age, Breed(Required)

Are your current pets up to date on?(Required)

Check all that apply

Vaccinations

Heartworm Preventation

Spay/Neutered

None

PART 3 - HOUSEHOLD INFORMATION

Name of Spouse

Spouse Phone

Spouse E-mail

List the name(s), relationship, and age(s) of all people living at your current address:

Where do you live?(Required)

How long have you lived at this address?(Required)

If other, please explain:(Required)

If renting, please provide the name and phone number of your landlord or property manager. We may need to contact them to confirm they have granted permission for a pet to live on the premises.

If renting, do you know the amount of your pet deposit? If so, please provide the pet deposit amount:

If you rent, are there any restrictions for pets living on the premises? If so, please list all restrictions:

Are you (or your spouse) Active-duty military?(Required)

Mark only one

Yes (self)

Yes (spouse)

Both

Do you travel often? if so, how often and who will provide for this animal while you are gone?(Required)

PART 4 - PET CARE INFORMATION/ EXPERIENCE

I am adopting this animal for:(Required)

Check all that apply

Myself

My Family

Friend/Relative

Would you be willing to accept and work to train an animal that has not been housebroken?(Required)

Mark only one

Yes

Why do you want a dog?(Required)

Check all that apply

Companion

Family Pet

Companion for another animal

Child's Pet

Hunting/Gaming Dog

Breeding

Watchdog

Other

If other, please explain;(Required)

How many hours per day will the dog be left alone without human companionship?(Required)

How many hours per night will the dog be left alone without human companionship?(Required)

Where will the dog be kept during the day?(Required)

Check all that apply

Indoors - Free Roam

Indoors - Crate

Confined to room or area

Garage

Outside dog run

Loose outside

Other

If other, please explain:(Required)

How will you exercise the dog?(Required)

Check all that apply

Leash walks

Let dog run in a fenced area

Let the dog run in an unfenced area

Cable run in yard

Dog run in yard

Walks in the park

Running/jogging partner

Dog park

Other

If other, please explain:(Required)

Do you have a fenced yard? If so, what type?(Required)

Select only one

Wood

Metal/Iron

Chain Link

Vinyl

Other

No Fence

What is the height of your fence?(Required)

Select only one

4 feet

5 feet

6 feet

7 feet

8 feet or above

N/A

Who in the household will be responsible for feeding, caring for, and if necessary, housebreaking the dog?(Required)

Myself

Spouse

Child

Relative

Family

How many years of experience does the person responsible for the dog have in housebreaking and training?(Required)

Do you plan to take the dog to professional training classes?(Required)

Yes

Are you prepared for chewing, digging, scratching, house-training, and other mischievous behavior?(Required)

Yes

Briefly describe how you would reprimand the dog:(Required)

Have you ever experienced behavioral problems with your dog(s)?(Required)

Yes

If yes, please explain:(Required)

Describe any events or circumstances that would prevent you from keeping the dog for his/her lifetime:(Required)

If you had to move to a place where pets were not allowed, describe how you would handle the situation:(Required)

Have you ever taken an animal to a rescue group, pound, or animal shelter?(Required)

Yes

If yes, under what circumstances?(Required)

Briefly describe your thoughts about keeping a collar with pet identification tags on pets at all time?(Required)

Have you ever had a pet die at an early age?(Required)

Yes

If yes, please explain:(Required)

If the animal you adopted was not working out in your household, briefly explain what you would do:(Required)

If you adopted an animal that was not housebroken and after 4 weeks was still not housebroken, briefly describe how you would handle the situation:(Required)

Please use this space to provide any further information you feel is relevant.

PART 5 - VETERINARY INFORMATION

Do you currently have a local veterinarian that you use?(Required)

Yes

Name of current Veterinary Clinic:(Required)

Clinic Address:(Required)

Clinic Phone Number:(Required)

Name your records are under:(Required)

If you do not currently have a local veterinarian, would you like us to recommend one?(Required)

Yes

PART 6 - CONSIDERATIONS

Have you considered that the final commitment of a pet could exceed several hundred dollars per year?(Required)

Yes

Are you aware that pets have physical and emotional needs and suffer from fear, pain, sadness, loneliness, happiness, and joy, just like people do?(Required)

Yes

Are you aware that most behavioral issues with animals can be corrected through proper training?(Required)

Yes

Are you aware that the adoption of an animal is a commitment for the life of the pet and that could be a 15–18-year commitment?(Required)

Yes

How long have you been looking for a dog?(Required)

Where did you learn about VDR and our animals for adoption?(Required)

Do you understand that some VDR animals, having been abandoned by their previous owners, may come with "baggage" and may have separation anxiety, may need to re-learn how to live in a home environment and to bond with your family and other pets?(Required)

Yes

Would you be willing to have an in-home or virtual visit by a VDR representative?(Required)

Yes

Dogs require a lot of your time, love, and attention. The cost of caring for a dog includes food, vaccinations, testing, boarding, and veterinary care during emergencies. Please consider these requirements when adopting a dog and be sure you are willing to commit to a new family member who may be with you for the next 15-18 years. Thank you for your time!

Have you adopted from VDR before?(Required)

Yes

Temporary foster homes are always desperately needed by VDR. Are you interested in providing a temporary home for an animal in need through our foster program?(Required)

Yes

If yes, what type of animal?(Required)

Dog/Puppy

Cat/Kitten

Bottle Feeding

May a VDR volunteer contact you in regard to our foster program?(Required)

Yes

Do you agree to contact VDR first, if an adopted dog was not working out in your home and needed to be re-homed?(Required)

Yes

Affirmations and Permissions(Required)

I hereby aﬃrm that I answered the above questions truthfully and to the best of my knowledge. I give my permission to VDR to contact the landlord, and veterinarian I have provided for references, and I give my permission for the release of any information they deem relevant to the adoption of an animal from VDR.

I agree to these affirmations and permissions

Adopt a Dog

Adoption Process

Adoption Q&A