Adoption Application - DaisyLu Ranch

Application

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Home Phone

Work Phone

Email(Required)

Enter Email Confirm Email

Emergency Contact(Required)

Please enter your emergency contact incase we are unable to reach you

First Last

Emergency Contact Phone(Required)

Dog Details

Name of desired dog

Why are you interested in this dog?

Why are you interested in a senior dog?

Household & Background Details

Who shares your household?(Required)

Check all that apply.

Spouse

Significant Other

Roommate

Children

Live-in

Other

Type of dwelling?(Required)

House

Condo

Apartment

Other

Do you rent or own?(Required)

Rent

Own

Please list everyone who shares your household.(Required)

Name

Relationship (Spouse, Partner, Roommate, Child)

Age

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

What percentage of time will the dog be in the house?(Required)

Which rooms, if any, will be off limits to the dog?(Required)

Where will the dog sleep at night?(Required)

Be specific

If the dog needs to go to vet, will you be able to take him/her?(Required)

Yes

How often do you take your dog for a regular checkup?(Required)

When you go to work, where will the dog be?(Required)

House

Yard

Other

Do you have a doggie door?(Required)

Yes

About how many hours will the dog be left alone during the day?(Required)

Be specific

Who has access to your yard?(Required)

Check all that apply

No one has access

Family members

Gardener

Pool Cleaners

Utility workers

Neighbor

Other

Do you trust these workers to not let the dog out?(Required)

Yes

Do you have a housekeeper who enters your home when you are not home?(Required)

Yes

Where will the dog be while they are working?(Required)

What outside areas are available to the dog?(Required)

Check all that apply

Fenced yard

Enclosed patio

Garage

Dog house

Unfenced common area

Other

Which of the following is used to secure your gate?(Required)

Check all that apply

Fenced yard

Latch

Keylock

Deadbolt

Padlock

Other

Who, in your house, will be mostly responsible for feeding the dog?(Required)

Other

How many times per day will you feed the dog?(Required)

Once

Twice

Three

What method do you use to housebreak your dog?(Required)

What kind of exercise will you provide the dog?(Required)

In which of the following situations are you able to have your dog off leash?(Required)

Park

Hike

Beach

Neighborhood walk

My front yard

Other

What discipline will you use if you dog chews your favorite shoes?(Required)

How would you disciplines your dog if he just won't listen or behaves?(Required)

Spank with hand

Spank fanny with newspaper

Swat nose

Stern voice

Scruffing

Other

Under what circumstances will you not keep the dog you are adopting?(Required)

Not house broken

Chases cats

Doesn't get along with other dogs

Dog digs a lot

Dog nips at strangers

Dog loses control of bladder

Dog develops chronic illness

Dog just un-trainable

Dog is not the kind of dog you thought it would be

Having a baby

Other

Animal History

Please list any animals you have previously owned.(Required)

Name of Animal

Breed

Male/Female

Sterilized (Yes/No)

How long did you own the animal?

What happened to the animal? (Still own, passed away, lost, surrendered, etc.)

Please provide the name and location of your current vet.(Required)

Explain why and how you can offer an outstanding home for a senior dog.(Required)

Additional Comments