S.A.R.G. Dog Adoption Application Form/Contract

Please fill out the following information and press the SUBMIT button. Required fields are marked with an *. If you prefer, click here for a printable adoption application to fill out and mail (PDF format).

1.   All current home animals must be vaccinated per your veterinarian's protocols.
2.   Dogs must be leashed at all times when outside unless in a fully fenced area.
3.   Dogs must be indoor dogs where they can be loved, participating family members.
4.   Below you will be asked for a special code. The code is SARG2008.
5.   All animals in the home must be spayed or neutered.
6.   We do not adopt dogs to be used for hunting, guarding, or breeding.

In filling out this application, I (we) agree to these adoption policies for dogs.

	If you do not agree to abide by these policies, it is very unlikely that we will be able to proceed with an adoption. If for some reason you DO NOT agree, please explain. Input is limited to 400 characters.

Pet name*

Application date *

Name of Applicant*	Name of Co_applicant
Home Address: Street/Apt. No.*	City*

County*

State*

Zip*

Years at Residence*

Primary Phone*	Secondary Phone
Work Phone	May we call you at work?
Occupation*	E-mail

Best time to contact you for a phone interview*

Please enter the special code*

Please give an alternate contact, who is NOT in your household, in case we can't reach you:

Name	Address
Phone	E-mail

Please tell us about the members of your household:

*Number of men 18-25:**	26-30:	31-60:	Over 60:
*Number of women 18-25:**	26-30:	31-60:	Over 60:

Number of boys:*

Ages:

Number of girls:*

Ages:

If you do not have children, are you pregnant or planning a family in the future?*

Are other children frequently in the home?*

If yes, give age range

How often?

How many at once?

Please tell us any additional information about your family (such as pet allergies, family members with disabilities that might be adversely affected by having a dog, special situations or circumstances, etc. Input is limited to 320 characters.)

Are all household members in agreement to adopt a pet?*

Do you live in a:* Do you own or rent?*

      If you rent, do you have the permission of your landlord to have a pet?

      Landlord Name: Landlord Phone

      Please explain the pet policy where you rent: (Input is limited to 320 characters.)


(We reserve the right to call and check to ensure this information is correct, or require written approval from the landlord.)

Have you had any pets in the last five years?*
     If so, please fill in the following: (Please list the name of your pet as it's registered at the vet's office)

Name of Pet Gender Spayed / Neutered? Age Type of Pet Breed What happened to the pet?

Have you sold, given away, or surrendered a pet to a shelter?*
      If yes, please explain: (Input is limited to 320 characters.)


What circumstance(s) would cause you to relinquish your dog back to SARG?* (Input is limited to 320 characters.)

Do you have a veterinarian that you currently use?*

   If so, please give your current vet's name and phone number, the name(s) of the pet(s) in their records, and the first and last name you are listed under:

      Current Vet Name Phone

      Pet Name(s) Person's Name on vet records:

   If you currently have a veterinarian, do you plan to use the same vet for the dog you are applying for?

If you have no current veterinarian, or do not plan to use your current vet for this animal, please give the name and phone number of the veterinarian you expect to use.

   Vet Name: Phone No.

Please list all other veterinarians you have used in the last five years, the name(s) of the pet(s) in their records, and the first and last name you are listed under at each vet's office:

Vet Name Phone

Pet Name(s) Person's Name on vet records:

Vet Name Phone

Pet Name(s) Person's Name on vet records:

Vet Name Phone

Pet Name(s) Person's Name on vet records:

Do we have your permission to contact any or all of these veterinarians as references?*

Please contact your veterinarian(s) to let them know we'll be calling for references.

What heartworm preventative will you use?*

What flea control product will you use?*

Please list two personal references that we have permission to contact. (References cannot be family or household members. Providing e-mail addresses for your references will expedite the process.)

Reference #1* Phone*

E-mail Best time to contact*

Reference #2* Phone*

E-mail Best time to contact*

Please tell us why you want a dog. Tell us about your household's daily routine and how a dog would fit into that routine. Please include information such as the activity level around your house (quiet and laid-back, moderately active, very active). Also include any activities that you'd like to do with a dog. (Input is limited to 400 characters.)*



Where will the dog be when you are home?*(Be specific--have run of house, blocked-off area of house, garage, fenced yard, crate, etc.)

How many hours per day will the dog be left alone?
       Monday through Friday?*        Weekends?*

Where will the dog be at night?*
Where will the dog be when you are gone?*(Be specific)
How much time will your dog spend outdoors?*

Do you have a fenced yard?*
       If yes, please describe (type, height, etc.)
       Do you consider the fence to be secure?
       Are you willing to make repairs if necessary?
       If no fence, how will you exercise the dog?
Would you ever tie a dog up outside?*
       If yes, under what circumstances? (Input is limited to 320 characters.)


Would you ever allow your dog off leash?*
       If yes, under what circumstances? (Input is limited to 320 characters.)


Dogs, just like humans, make mistakes. Every dog requires ongoing training to teach him/her how to be a responsible, happy member of the family. Please explain how you plan to train a new dog. (Input is limited to 320 characters.)*


Would you be interested in taking your dog to formal obedience training classes?*

How would you discipline your dog?


Do you plan to use a crate (portable cage) as a housebreaking and/or transitional aid while your dog is adjusting to his/her new surroundings?*
A dog can live 15 years or longer. Are you committed to caring for this dog for its lifetime?*

Do you realize that the cost of owning a dog could run between $500-$1,000 per year? (Vet visits and yearly vaccinations, flea/tick/heartworm preventatives, food, toys, training, equipment, boarding, food, grooming, etc.)*
        Are you prepared to make this kind of financial commitment to your dog?*

Do you have a regular groomer?*
        If yes, may we contact the groomer for a reference?*
        Groomer's Name        Groomer's Phone

Would you agree to a home visit prior to adoption?*

How did you hear about S.A.R.G. and/or the animal you wish to adopt?*
       Poster or showing location, or other information source:

ADDITIONAL COMMENTS/INFORMATION
You may use this space to add any additional information you would like us to consider. (Input is limited to 480 characters.)

Would you like to receive emails regarding future events and fundraisers?

Would you consider volunteering with S.A.R.G.?

If Yes, in which of the following areas? (Place an "X" beside all that apply.)
Fundraisers    Dog washes    Vet checks    Financially    Telephone Calls
Fostering    Transportation to/from events or vet appointments    Mailing newsletters
Home visits to potential adopters    Making craft items to donate for fundraisers
Other talents (legal services, web design, accounting services, sponsorship etc.):

I/We understand that this application, if approved, also serves as a contract between S.A.R.G. and me/us, and that completion of the application does not guarantee that the adoption will be approved.

I/We have read and understand all the Terms and Conditions of Adoption, as indicated by my/our signature on this page, as well as on the separate document explaining those Terms and Conditions. I/We understand that those Terms and Conditions are part of the Adoption Agreement and will be enforced. I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/We attest that I/we have retained a copy of the Terms and Conditions of Adoption.

I/We agree to pay the adoption fee of $145 for a dog. For this fee, S.A.R.G. will see that the animal is spayed/neutered and is current on standard vaccinations at the time of adoption.

Do you affirm that the above information is true and accurate?*

Note: This form will be printed and you will be requested to sign it at the time you receive an animal from us, if the adoption is approved.

Rev. 5/4/2008

Name of Pet	Gender	Spayed / Neutered?	Age	Type of Pet	Breed	What happened to the pet?

Current Vet Name	Phone
Pet Name(s)	Person's Name on vet records:

Vet Name	Phone
Pet Name(s)	Person's Name on vet records:

Vet Name	Phone
Pet Name(s)	Person's Name on vet records:

Vet Name	Phone
Pet Name(s)	Person's Name on vet records: