Dog Adoption Form

Interested in Adopting a pet from Big Canoe Animal Rescue? Please fill out the application below to be considered. Applicants must be 21 years of age or older. Adoption Fee of $175 for dogs and $100 for cats is due at the time of the final adoption.

Name of the dog you would like to adopt:

Applicant's Name: *

Applicant's Age: *

Applicant's Occupation: *

Co-Applicants Name:

Co-Applicants Age:

Co-Applicants Occupation:

Street Address: *

City: *

State: *

Zip: *

Home Phone Number: *

Cell Phone Number:

Email Address: *

List all residents (people) living in the home with their ages: *

Are you willing to allow a representative from B.C.A.R to visit your home by appointment: * YesNo

Do you own the home where you live?: * YesNo

If yes, what type of home do you own?: * Single Family HomeCondoTrailer HomeTown Home

If no, please email a copy of your rental agreement to bigcanoeanimalrescue@gmail.com

Does your Home Owners Association, city or county have ordinances specifying dog breeds that are not allowed? If yes, please explain: *

Do you have a fenced yard?: * YesNo

If yes, state type of fence and height:

If yes, is there direct access to the fenced area from your home?: * YesNo

What is your reason(s) for adopting this dog? *

How many times have you moved in the past 5 years: *

If you moved in the last five years, did your pet go with you?: * YesNo

Would you ever consider moving somewhere that does not allow your pet(s)?: * YesNo

Does anyone in your household currently have serious health problems?: * YesNo

Please explain

Is anyone in your household allergic to dogs?: * YesNo

List type and age of all pets currently in the household (include dogs, cats, ferrets, retiles, birds, hamsters, fish, exotic animals, etc.) *

Please provide short history of all dogs owned within the past 10 years (include dog’s name, breed, size, endearing qualities, and if applicable age at & cause of death): *

If you owned dogs in the last 10 years, were they all spayed or neutered? If no, please explain: *

If you owned dogs in the last 10 years, were they kept up to date on their vaccinations? If no, please explain.: *

Are your current dogs spayed or neutered? If no, please explain: *

Do your current dogs or did any of the dogs you owned in the past 10 years primarily live outdoors?: *

Do you know what heartworm disease is and how to prevent it?: *

If you own a dog or have owned a dog in the last 10 years, did you give it heartworm preventative routinely? If yes, what kind?: *

How do you plan to prevent flea and tick infestation of your dog?: *

How many hours will this dog be home alone on a typical day?: *

Where does your current dog stay when home alone during the day?: *

What percentage of the time will the new dog spend inside the house (excluding walks and supervised exercise)?: *

Where will the new dog sleep at night?: *

Have you ever house trained a dog?: *

If yes, describe your method. *

Have you ever had a serious behavior problem with a previous dog? *

If yes, please describe the problem and the method used to correct it. *

Have you considered what you will do if there comes a time when you are no longer able to keep or care for your pet? *

If yes, what are your plans?*

Are you familiar with any dog parks near your home?*

Under what circumstances is it okay to leave a dog outside alone unsupervised in an unfenced area? *

What circumstances justify giving a dog away? *

Have you had any dog for over three months that did not work out? *

If yes, please explain the circumstances and what happened to the dog: *

References (provide two) names, email addresses, and phone numbers: *

If you currently own a pet, veterinarian’s name, email address, and phone number: *

Please provide any additional information that provides insight into why you would like to adopt this dog.: *