CANINE SHELTER RESCUE
P. O. Box 7025, N Augusta, SC  29861-7025

canineshelterrescue@yahoo.com

ADOPTION APPLICATION

for

DOGS/PUPPIES
First & Last Name:
E-mail Address :
Address:
City:
State:
Zip:
Phone:
Cell:
Fax:
Best Time To Call:
1) Name of the dog/puppy of interest:
2) Why do you want this dog?
3) What type of housing do you reside in?
4) Do you Own or Rent?
Does the lease/landlord permit dogs?
5) Do you have a fenced yard?
6) Household consists of:  
Number of Adults: Number of Children:
7) Do any household members have allergies?
Yes No
If Yes, please explain:
8) Pets already living in your home:
If Yes, please explain:
9) Do your other pet(s) live inside or outside?
Comments:
10) Where will this dog/puppy live?
11) Are your other pet(s) spayed/neutered?
If no, why not?
12) Please provide what method you use for:  
Heartworm Preventative:
Flea/Tick Control:
13) Veterinarian Information (***REQUIRED***)
Doctors Name:
Phone :
Address:
City:
State:
Zip:
14) Do you have and intend to use a crate for this dog/puppy?
Size:
How many hours per day will dog be confined?
15) How do you discipline your dog(s)?
 
16) What type of training do you plan to use with this dog?
17) What happened to your last pet?
18) Groomer Information (REQUIRED for certain breeds, when specified)
Doctors Name:
Phone :
Address:
City:
State:
Zip:
19) Would you allow a home inspection or
post-adoption follow-up by a Canine Shelter
Rescue volunteer?
20) Personal References (**REQUIRED**) for 3 people (outside your household) who know your animals:
Reference #1 Name:
Phone :
Address:
City:
State:
Zip:
Reference #2 Name:
Phone :
Address:
City:
State:
Zip:
Reference #3 Name:
Phone :
Address:
City:
State:
Zip:
21) How did you hear about Canine Shelter Rescue?
22) Any questions or comments you would like to include: