unaltered dogs 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

Do you own an electric fence?

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? *

Any behavioral issues with your current pet(s)?

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 or in the past 10 years, 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.: *

Big Canoe Animal Rescue (BCAR) appreciates your patience throughout the application process. Our goal is to make sure that the dogs in our care are placed in the right home for the dog, and the Adopter. With submission of this application, I acknowledge, and agree to the following:

• BCAR has permission to contact my vet and other references during the application process.

I agree

• BCAR has the right to refuse any adoption, for any reason.

I agree.

• I certify that the above information is true and correct.

I agree

• On behalf of yourself, your heirs, and your personal representatives, you hereby release and hold harmless BCAR, its Board of Directors, and other volunteers from any and all liability, claims, demands, losses, and causes of action which may arise from any activity occurring during the adoption process including walking the rescue dog, any meet and greet, and any liability associated with a home visit.

I agree.

• You agree that you are financially responsible for the cost of any medical care received for any injury incurred during the application and adoption process.

I agree.

Additional Comments

Phone

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