Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell

Work

Email *

Employer *

How long at current job *

References

Provide two references that are not members of your immediate family:

Personal reference #1: *

First

Last

Phone *

Relationship *

Years Known *

brand pet go

Personal reference #2: *

First

Last

Phone *

Relationship *

Years Known *

Home Environment

Do you live in a(n)? *

House
Apartment/Condo
Townhouse
Other

If you chose Other, please specify:

Is your home...

Owned, by you or your spouse/life partner
Owned, by someone else within the house
Rented directly from the owner or through a management company
Rented as a part of a group of roommates
Other

If you chose Other, please specify:

If renting, is your name on the lease? *

Yes
No

If renting, do you have your landlordʼs permission to have a dog? *

Yes
No

Landlord's name and phone: *

Who shares your household?

Spouse/Life Partner
Boyfriend/Girlfriend
Roommate(s)
Other

If you chose Other, please specify:

Are there children in the home?

Yes
No

If yes, how many? How old?

At what age do you feel children are responsible enough to take care of a pet without assistance? (i.e. walk, feed, train) *

If your present relationship/ living situation were to change and you were no longer able to care for the pet, a new application must be submitted and approved in order to transfer ownership. *

I have read and understand.

Do you plan to move soon? *

Yes
No

Does anyone in your household have an allergy to this pet that you are aware of? *

Yes
No

Is someone home during the day? *

Yes
No

Who?

How many hours will your pet be alone each day?

Where will your pet spend most of his/her day when you are home?

If you chose Other, please specify:

Where will the pet stay when he/she is home alone?

Indoor/outdoor (doggy- door)
Inside only
Outside only

If inside only, please specify:

Run of the house
Crate
Specific Rooms

If specific rooms, please share:

If outside only, please specify:

Yard
Garage
Enclosed Patio
Other

If Other, please share:

When will the pet be inside?

When will he/she be outside?

Where will the pet sleep at night?

Indoor/outdoor (doggy- door)
Inside only
Outside only

If inside only, please specify:

Run of the house
Crate
Specific Rooms

If specific rooms, please share:

If outside only, please specify:

If Other, please share:

What rooms are off limits?

Yard Environment

Do you have a yard? *

I do have a yard.
I do not have a yard at this time.

What outside areas are available to the pet? (check all that apply)

If you chose Other, please specify:

Do you have a doggie door?

Yes
No

Is your yard shared with neighbors?

Yes
No

Is your yard fenced?

Yes
No

What type of fence?

Fence height?

Highest point

Lowest point

Have you recently inspected your fences?

Yes
No

Are they in good condition with no holes or loose points?

Yes
No

If your pet will have free access to a fenced yard, where is it located?

Which of the following is used to secure your gate?

Why don't you lock your gate?

If you chose Other, please specify:

If your gate does not have a lock, are you willing to install one?

Yes
No

Who has access to your yard?

If you chose Other, please specify:

Where is the pet kept while they are working?

Do you trust your workers not to let the pet get out?

Yes
No

Your Experience with Dogs

How would you describe your pet owning experience?

I have had dogs or cats of my own as an adult
I grew up with dogs or have worked with them but have not had my own as an adult
I have never had one or have limited experience with dogs or cats
Other

If you chose Other, please specify:

Have you owned a pet of this breed before?

Yes
No

If no, what is your experience with them?

What do you appreciate about this breed/pet type?

How are you prepared to address behavior issues should it arise? Please be specific:

How many pets have you owned in the past 5 years?

What happened to the other pets?

Do you currently have pets?

Yes
No

If yes, please include the type, breed, gender, age, whether they are spayed/neutered:

How do you feel your current pets will adjust to a new pet in the house?

Have you had experience with behavioral or medical issues with your previous or current pets?

Yes
No

If yes, please describe:

If there are children in the household, please describe their experience with pets:

About this pet

Why do you want to adopt this rescued pet?

Share your reasons for wanting a pet? (check all that apply)

If you chose Other, please specify:

How will you exercise your pet? How often?

What type of training are you interested in doing with your pet?

Have you or would you be willing to enroll your current dog(s) in obedience classes?

Yes
No
Only if I had problems

How would you discipline your pet if he or she misbehaved/ chewed household items?

What method do you intend to use to housetrain your dog? (check all that apply)

If you chose Other, please specify:

If your pet develops behavioral problems, what will you do?

In which of the following situations might you allow your dog off leash?

Additional Information

If your pet got out/ was lost, what would you do?

What food will you feed the pet?

Dry food
Canned food
Other

What dry food will you feed the pet? (Specify brand if known)

What canned food will you feed the pet? (Specify brand if known)

If Other, please specify:

Would you like food recommendations?

Yes, please
No thank you

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new pet?

Yes
No

Other concerns:

Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as long as 15 years or more?

Yes
No

Other concerns:

What is your monthly budget for your pet?

Who is your veterinarian (name and phone)?

If you move, what will you do with your pet?

Which of the following reasons might force you to give up your pet? (Check all that apply):

If Other, please specify:

Additional comments about why you would like to adopt this particular pet:

Is there anything else you would like to share about with us?

Please read and initial each statement below:

I understand that a home visit is required prior to final placement. *

I have read and understand.

I understand that a home visit does not guarantee placement. *

I have read and understand.

I agree to provide my own collar, leash and a personal ID tag at the time of completing the adoption contract. *

I have read and understand.

I agree to provide a $20 non refundable application fee to submit this application. All fees will go directly to Creekside Cares Alliance. *

I have read and understand.

I can give a gift of $_______ to help offset the costs incurred preparing this pet for adoption. I understand that any donation or contribution is a gift freely given, not a purchase price for a dog. *

I have read and understand.

Please list the gift amount here:

We reserve the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract.

Online Forms

Adoption Application