Dog Adoption Form - Big Canoe Animal Rescue

Name of the dog you would like to adopt:

Applicant's First Name: *

Applicant's Last Name: *

Age: *

Occupation: *

Co-Applicants First Name:

Co-Applicants Last Name:

Age:

Occupation:

Address: *

City: *

State: *

Zip code: *

Home Phone: *

Cell Phone:

Email Address: *

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

Yes
No

Do you own a home?: *

Yes
No

If yes, what type of home do you own?: *

Single Family Home
Condo
Trailer Home
Town Home

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

Please list all current residents (people) of the home (other than the applicants), including names and ages.: *

Do you have a fenced yard?: *

Yes
No

If yes, state type of fence and height:

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

Yes
No

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

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

If you owned a pet, did it go with you?: *

Yes
No

Would you consider moving somewhere that doesn't allow your pets?: *

Yes
No

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

Yes
No

Is anyone in your household allergic to dogs?: *

Yes
No
Third Choice

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 control fleas and ticks?: *

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.: *

Phone

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