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Pet Orphans Guest Adoption Application

If you are interested in adopting a pet please fill in the following information and click on the submit button at the bottom of this page. Please note that Pet Orphans' rescue groups do NOT adopt outside of Georgia, and some rescue groups will not adopt outside of the Atlanta area. It may take up to 3 days to get a response from us regarding this application, so please be patient. Most responses are initially via e-mail, so be sure your e-mail address is accurate, and check your e-mail regularly for a reply from us.

Pet Orphans reserves the right to refuse any applicant.

First Name : Last Name :
Street address :
City : State : ZIP :
Home Phone : Work Phone :
Age : Occupation :
E-mail (required field) :

What is the name of the foster home and the dog/breed you are interested in?

List any general questions you would like ask about this particular dog.

Are you willing to allow a representative from Pet Orphan Rescue to visit your home by appointment? Yes No
Please check any of the following reasons for adopting this dog:   family pet child's pet watchdog companion hunting dog guard dog for business companion for other pet gift other - please specify:
Please describe where you live: apartment house condo/townhouse trailer/mobilehome
Do you... rent home own home
If you rent, do you have the landlord's permission to own a dog? Yes No
      What is the apartment complex name?
      What is the landlord's phone number?
How many times have you moved in the past 5 years? times
If you move, will your pet go with you? Yes No
Do you foresee any major changes in your life in the next 15 years (average lifespan of a dog) such as marriage, children, health problems due to age, going away to college? Yes No
If yes, please explain
Do you or anyone in your household currently have any serious health problems? Yes No
If so, please describe:
Can you provide a permanent home for this dog for 10-15 years? Yes No
Do you have a fully fenced yard with no gaps? Yes No
If yes, how high and what kind?
Number of adults in household?
Relationship(s):   spouse   roommate(s)   life partner   other - please specify:
Will this dog be a surprise for any family members? Yes No
If yes, who?
Do any family members have allergies? Yes No
Do any children live in the house? Yes No
If so, what are their gender/ages?
Number, type and age of pets currently in household?
Do any of your current or did any of your past pets live primarily outdoors? Yes No If yes, please describe pet:
Are all current pets and were all previous pets spayed/neutered? Yes No
Is your current dog or was your previous dog on heartworm prevention medication? Yes No
If yes, how often do/did you give the heartworm medication and what brand do/did you use?
What is your veterinarian's name and phone number?
Have you ever owned dogs in the past? Yes No
If yes, how many have you owned?
If yes, please describe what happened to each of them (put to sleep, run over, died of old age, sold, gave away, ran away, etc)
Who will be responsible for the daily care and training of your new dog?
Do you know what heartworm disease is and how to prevent it?
How do you plan to prevent fleas and ticks? Are you aware of Frontline or Advantage?
How many hours will the dog be home alone on a typical day?
Where will the new dog stay when home alone during the day? outside in fenced area outside in dog pen outside on chain or tie-out inside in basement in the garage inside free run of house inside in one room of house inside in crate ; Other, please describe
Where will the new dog sleep at night? dog house in fenced area dog house in dog pen dog house near tie-out inside in basement in the garage inside free run of house inside in one room of house inside in crate ; other, please describe

Where do current pets stay during the day and at night?

What percentage of time will the dog spend inside the house?
Have you ever had a serious behavior problem with a previous dog? If so, please describe
Do you have a doggie door? Yes No
If you work during the day, would you consider installing a doggie door?
Are you financially prepared to spend at least $600 a year on annual checkups, shots, sick vet checks, flea and heartworm prevention, dog food, treats, grooming, etc (plus initial expenses for collar, leash, ID, bowls, dog bed/crate)? Yes No
Are you willing to keep a collar and ID tag on all of your pets including a new dog at all times? Yes No
Under what circumstances do you think it is OK to let a dog outside alone and unsupervised in an unfenced area? In a quiet subdivision On a lot of acreage In a rural area When I know they are trained to come back None
What circumstances, in your mind, justify giving a dog up? moving new baby not getting along with other pets divorce getting out of fence behavioral problems children lost interest if it gets too big too time consuming shedding allergies housebreaking problems medical problems aggressive behavior ; Other, please explain
Have you ever given a dog up or had a dog for a brief period of time and it didn't work out? If so please explain the circumstances and what happened to it.
Have you ever looked at or applied for a pet with another rescue group? How long ago? Did you adopt? Please explain.
Please list the name, phone number, address of 2 personal references
If you are unable to keep your dog for any reason at any time will you return the dog to us? Yes No
Would you ever consider moving somewhere that doesn't allow your pets?
Has a dog or puppied died on your premises in the last 6 months of distemper, parvo or unknown causes? Yes No
How did you hear about Pet Orphans? website newspaper word of mouth radio at an adoption day

Typing your name below will serve as legal signature.

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue dog and possible removal of said dog from my home. Applicant must be 21 years of age or older. Pet Orphans reserves the right to refuse any applicant.