Adoption Application #1

Adoption Application

Thank you for your interest in adopting a new pet. The following information is required so that we can assist in the selection of your new family member. This form and consultation with an Eloise Rescue representative, is designed to help us best serve both the needs of our animals and our adoptors.

There is a $700.00Adoption fee

This fee helps Eloise Rescue cover costs associated with spay/neuter of your pet, current shots, micro chipping and temporary medical boarding, food, treats, collar leash and anything needed for each dog we rescue. Cost is usually any where from $700 on up per dog depending on if there are medical needs ie surgery or a parvo dog. A home check will be required as well as a binding contract to adopt a dog from Eloise Rescue along with mandatory training with our trainers!at a fee of $350.00 for 7 classes to be completed in 3 months time. No profits are made on any of our adoptions. Adoptions will only be considered to Los Angeles county residents and surrounding areas. We do not adopt out of state. (we make no exception for anyone who lives out of state or has an open swimming pool).

Name of the dog you are interested in: *

First Name, Last Name: *

Email Address: *

Please Re-Enter Email: *

Best phone number to be reached: *

Street Address and name of street. *

City & State *

Zip Code *

Occupation: *

How long have you been at your current job, and what do you do? *

Employer Phone Number: *

Age: *

What type of home do you reside in? *

House

Condo

Apartment

Other: Other:

Do You Own Or Rent? *

Own

Rent (Do you have written permission to have a dog?)

Do you have permission now to have a dog? Do you have permission now to have a dog?

With whom do you share your household? *

Are you planning on having children in the future? *

No

Yes

Do you have grandchildren that visit? *

No

Yes (Please let us know if they will be interacting with the dog and how often): Yes (Please let us know if they will be interacting with the dog and how often):

At what age do you feel a child is responsible enough to care for a dog without supervision? (i.e.walking, feeding etc?) *

What is your level of experience with dogs? *

First time owner

Beginner (just got a pet recently)

Intermediate (have had pets for a while, but not really trained them)

Advanced (you have studied obedience training under a professional dog trainer)

Expert (you are a professional dog trainer)

Do you currently have any pets, please include age, Breed, and type Ie... dog or cat extra ? *

Yes

No

Type of Pet(s):

Age of pets in home: Age of pets in home:

If you have had pets in the past that are no longer with you, please explain what happened (i.e. gave to someone else, lost, passed away to old age, etc.) *

Have you ever walked a dog off leash? *

No

Yes (Please explain): Yes (Please explain):

Would you walk your adopted dog on or off-leash? If off-leash, where and when? *

Have you ever given up a dog? *

No

Yes (Please explain): Yes (Please explain):

Have you ever allowed an animal to breed/have babies? *

No

Yes (Please explain): Yes (Please explain):

Do you have a veterinarian? If yes, please list name, number and how long you have used the vet: *

Does anyone in your household have allergies to dogs? *

No

Yes

Are you planning on moving or traveling in the next 12 months? *

No

Yes (Where and Why?): Yes (Where and Why?):

What's the main reason you'd like to adopt a dog (please check all that apply): *

Family Companion

Watch/Guard Dog

Entertainment for Children

Companion for Another Pet

If your present relationship were to change, with whom will the dog remain? *

Will all household members be able to come and meet the dog at a scheduled adoption appointment? *

Yes

No (Please explain): No (Please explain):

Do you have a yard? *

No

Yes

Do you have an electric driveway gate? *

No

Yes (if yes, will the dog have access to the driveway when the gate is opening and closing?) Yes (if yes, will the dog have access to the driveway when the gate is opening and closing?)

Do you have a doggy door? *

No

Yes (Where in the house and is it always accessible?) Yes (Where in the house and is it always accessible?)

Do you have a pool? *

No

Yes

If yes: (is it fenced off describe) If yes: (is it fenced off describe)

Do you have a Gardener, Housekeeper, Poolman (etc)? *

No

Yes

what do you do with your pet when they are in your home: what do you do with your pet when they are in your home:

Do you have any poisons (rodents, snail bait, plant food) where the animal will be kept? *

No

Yes

Is someone home during the day? *

No

Yes (Who?) Yes (Who?)

How many hours a day will the dog be alone? *

If the dog will be alone for more than 6 hours a day, what are your plans for the dog during this time? *

Which rooms, if any, are off limits to the dog? *

Will the dog be allowed on the furniture? *

Yes

No

Some furniture

What activity level are you looking for in a dog: *

Couch potato

Short walks

Intermediate (2-3 long walks a day)Active (long walks, hiking, jogging partner)

Agility training

Will you be able to exercise your dog on a regular basis? How many times a day will you be walking your dog? *

No

Yes (Please explain type of exercise) Yes (Please explain type of exercise)

What kind of walking device would you use? (Ex: harness, choke chain, pinch collar, head halter, etc)? *

Where will the dog be kept during the day exactly? *

Where will the dog sleep at night exactly? *

What plans would you have in place for your dog when you travel? (Ex: hired petsitter, friend who stops by to feed, dog will stay at a kennel, dog travels with you, etc) *

What type of food would you feed your dog, and what is your present dog eating if applicable? (If commercial food, please state brand, and if the food is canned, kibble, dried, raw, etc): *

Who will be responsible for feeding the dog and walking the dog? *

Will your dog wear a collar and identification tag? *

Always

Never

Sometimes (Please Explain) Sometimes (Please Explain)

If your new dog gets out, which of the following would you do? (fyi all our dogs are microchipped in the rescue and our vets name only)Check all that apply: *

What method do you intend to housetrain your dog? *

What discipline would you use if your dog chewed your favorite shoes? *

What is a behavior that would not be acceptable to you? *

How would you train or discipline a dog? *

Have you and or would you be willing to train a dog in obedience class at your own expense? *

If your pet becomes ill, gets injured, needs surgery or ongoing medical care, what amount of money are you willing to spend on veterinary/medical care? *

Would you consider getting pet insurance for this animal? *

Yes

No (Please explain): No (Please explain):

What might cause you to give up your dog? Check all that apply: *

A dog can live to be 15 to 20 years old. Are you able to make this long-term commitment? *

Yes

No (Please explain): No (Please explain):

Who would care for this dog in the event something happened to you or you could no longer care for your pet? *

Have you ever tried to adopt an animal from another rescue group? *

No

Yes (Please explain):

If there is anything else that you would like to tell us about you or your family, please feel free to write your comments here. *

Please write what a typical day with your dog would be, from getting up in the am to going to bed at night. Please give detail? *

I understand that a home visit is required and that a home visit does not guarantee placement: *

I Agree

I Do Not Agree

I understand that submitting an application does not mean I am approved to a adopt a dog from Eloise Rescue. Eloise Rescue has the right to refuse adoption to any applicant for any reason and is not obligated to provide a reason or explanation for refusing adoption to an applicant: *

I Agree

I Do Not Agree

Allergies	Accidents in house
New spouse doesn't like dog	Financial reasons
Biting/aggression	Dog is hard to train
Dog gets sick	You get sick
New baby	Moving out of state
Move to a place that dogs aren't allowed	Expensive vet bills
Dog barks a lot	Dog growls or nips at strangers
Dog bites children	Dog loses control of bladder
Dog doesn't get along with current pet	Aggressive with other dogs
Neighbors complain about pet	Poor watchdog
Jumping on people	Not the kind of dog I thought it would be
None of the above