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Dog Adoption Application

1Applicant

2Family

3Home

4Care

5Preferences

Hidden
Default: Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country*
Home Phone Number
Work Phone Number
Cell Phone Number*
- Preferred Method of Contact
- How Did You Hear About Us?*
- What Is Your Friend's Name?*
- Which Shelter?*
- Which Rescue?*
- Please Describe*

Below are areas for information on other members of your family. Please include all other Dogs and Pets living in your home by clicking on the designated button.
Are There Other Dogs In The Home?*
- Yes
- No

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Dog's Name	Breed	Age Range	Gender	Actions

There are no Dogs.

Maximum number of dogs reached.

Are There Other Pets In The Home?*
- Yes
- No
Add Pets
Animal Type Actions
There are no Pets.
Maximum number of pets reached.

Residence
- Type of Residence*
- Please Describe Type of Residence*
- Do You Own or Rent?*
- Does Landlord Allow Dogs?*
  - Yes
  - No
- Are There Any Breed Or Size Restrictions?*
- Please Provide Landlord's Name*
- Please Provide Landlord's Phone Number*

Behavior & Training
Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Dog Comfortable In Your Home?*
- Yes
- No

Reason For Adoption
Select all that apply.
Family Companion*
- Yes
- No
Personal Protection*
- Yes
- No
For Child*
- Yes
- No
Gift*
- Yes
- No
Companion For Current Dog*
- Yes
- No
Replace A Previous Dog*
- Yes
- No
- Other
  - Yes
  - No
- Please Describe Reason For Adoption*
Would You Consider:
Fostering While Waiting For The Perfect Dog?*
A Mixed Breed Dog?*
Two Dogs?*
A Dog That Can Be An Only Pet?*
A Dog That Is Afraid Of Small Children?*
A Dog That Needs Medications?*
- A Dog That Has A Serious Health Condition?*
- Please Select All Health Condition(s) You Would Accept*
- A Dog Who Needs Training For A Behavior Issue?*
- Please Select All Behavior Issue(s) You Would Accept*
  Select All That Apply:
- A Dog that Has Special Needs?
- Please Select All Special Needs(s) You Would Accept*
  Select All That Apply:
- A Dog That is Not Completely Housebroken?*
Select Gender*
Select Age Range*
Select All That Apply
Select Personality*
Select All That Apply
Select Color*
Do You Have A Preferred Dog?
Note: This does not guarantee this dog will be placed with you
List Other Dogs You Are Interested In
When Will You Be Ready To Adopt?*
Is There Anything Else You Would Like to Let Us Know?
Authorization
Authorization:*
All dogs placed through the S.P.C.A. of Southwest Michigan will have health checks, personality and temperament evaluations, and will be spayed or neutered prior to placement unless a medical condition exists, diagnosed by a veterinarian, that would prevent this surgery. I further understand that all information on my Rescue Adoption Application will be kept confidential; that my application will be kept on file at the S.P.C.A. of Southwest Michigan.
- I understand and agree
Comments
This field is for validation purposes and should be left unchanged.

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