Your Full Name  
Address  
City  
Province  
Postal Code  
E-mail Address  
Home Phone Number  
Alternate Number  
Cell Number  
Are you older than 18?  

About The Dog You Are Looking For


1.  Name of the dog(s) that you are applying for:


If the dog is no longer available, would you be interested in us finding
another dog for you who would meet your criteria?



2.  Please describe what kind of characteristics you would like in
a dog in terms of:

Breed:


Temperament:


Energy Level (how often do you plan to exercise your new pet?):


Intelligence:


Grooming Level:


Overall Personality:


Other:



3.  Do you have experience with rescued animals? Please explain:




About Your Residence


4.  Do you own or rent? 


5.  If applicable, please provide the name and phone number of
your landlord or condo board:

Name 

Phone Number  


6.  You live in a   Single Family Home Apartment or Condo Townhouse Farm Mobile Home Acreage Other

If other, please specify 


7.  Do you have a fenced yard?   Yes No

If yes, how tall is the fence? 


8.  Would you agree to a home visit prior to the adoption?  





About Your Family


9.  How many adults and children are in your household?


What are the ages of the children?



10.  Is anyone in the household allergic to animals?


Has everyone been tested for allergies?



11.  Have all family members agreed to the adoption?  


12.  What has your family done to prepare for the arrival of a new pet?



13.  Sometimes circumstances in our lives change and will impact the dynamics of the family, for example, moving, marriage, babies, divorce, returning to school etc. Please explain how you will manage changes like these in terms of your commitment to your four-legged family member:



14.  Please list the pets that are currently in your home:

Species:
Breed:
Age:
Sex: Male Female
Spayed or Neutered: Yes No
If no, please explain:
How did you acquire this pet?



Species:
Breed:
Age:
Sex: Male Female
Spayed or Neutered: Yes No
If no, please explain:
How did you acquire this pet?



Species:
Breed:
Age:
Sex: Male Female
Spayed or Neutered: Yes No
If no, please explain:
How did you acquire this pet?



Species:
Breed:
Age:
Sex: Male Female
Spayed or Neutered: Yes No
If no, please explain:
How did you acquire this pet?



Species:
Breed:
Age:
Sex: Male Female
Spayed or Neutered: Yes No
If no, please explain:
How did you acquire this pet?



15.  Are your pets up-to-date on vaccines and medical issues?



16.   How long will the dog be left alone during the day?






Pet Guardianship History


17.  Please list each pet you have had in the past:

Species  
Breed  
How did you acquire this pet?
Where is this pet now?



Species  
Breed  
How did you acquire this pet?
Where is this pet now?



Species  
Breed  
How did you acquire this pet?
Where is this pet now?



Species  
Breed  
How did you acquire this pet?
Where is this pet now?



Species  
Breed  
How did you acquire this pet?
Where is this pet now?





References


18.  What is the contact information of your current veterinarian for any animals you have now or have had in the past 5 years?

Name  

Phone Number  

Do we have permission to contact your vet for a reference?  


19.  Pawsitive Match charges an adoption fee and these fees help to cover expenses incurred by the rescue. All dogs adopted through Pawsitive Match are spayed/neutered and up to date on vaccines. If they are too young to be spayed or neutered at the time of adoption, the adopter will make assure that this surgery is performed, and adoption fee will reflect this.

Please confirm that you are in agreement with the following statements:



I hereby certify that all statements are true. Should there be any changes I will notify Pawsitive Match Rescue as soon as possible.

I am aware this application must be approved before an adoption can take place.

I have read the application and understand its meaning and agree to its terms.

By submitting this application to Pawsitive Match Rescue, I agree and consent to the collection, use and transfer of my personal information contained in this application for the purposes of processing my application.



All submissions pertaining to this application do not contain or will not contain any untrue statement of fact or omits or will omit to contain a fact necessary to make any statement not misleading. There has been no event or information not disclosed in writing to Pawsitive Match which could reasonable be expected to have an adverse effect on the health, comfort, safety, or well-being of the rescue dog.



Date  

Electronic Signature