Application

Date *

Is there a particular dog on our site you are interested in? *

Your Information: *Full Name (First & Last)

*

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

How long have you lived there? *

Previous Address if less then 2 years:

Home Phone: *

Work Phone: *

Cell/Other Phone: *

Email *

How did you hear about UAWR? *

What is your domestic status? *

MarriedSingleLiving with roommate(s)Living with Partner/Significant Other

List Members of your household along with ages: *

If Married or Living with others, for how long? *

Do you have any children in your home? *

YesNo

Please list children's names & ages (type NA if no children) *

What type of home do you live in? *

HouseCondoApartmentMoble Home ParkTownhouseFarmDuplexOther

Do you: *

OwnRentLive w/ Parents

If Renting are you allowed to have pets? *

YesNoI Don't Know

Is there a weight and/or size limit? If Yes what? *

Landlord's Name & Phone Number

Do you have a fenced yard? *

YesNoI Don't Know/Other

If yes, describe fencing: *

How tall is the fence at the lowest point? Describe the type of fencing? What type of gate and how tall is the gate?

Do you own a pool? *

YesNoI plan to soon

If yes, my pool is:

Not Covered or FencedPet Safe FencedCoveredCovered and Fenced

Employment Information: *Company Name

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Phone

How long employed with this company? *

How many hours per day will this dog spend along each day? *

Adult home all dayGone 1-5 hours (including travel time)Gone 6-8 hours (including travel time)Gone 9-12 hours (including travel time)Gone 13+ hours (including travel time)

How many days per week? *

Where does the dog stay while you are at work or away from home? *

When you go on vacation, who cares for the dog? *

Family/RelativeFriendMy dog stays at a boarding facilityOther

Do you currently own pets other then dogs? *

YesNo

If Yes how long?

Type and Age of animals currently owned other then dogs: *

Do you currently own a dog(s)? *

YesNo

If yes, Please list each dog:

1. Breed 2. Age 3. Spayed, Neutered, or In Tact 4. How long have you owned? 5. Personality type (Aggressive, Dominate, Submissive, etc.)

Where are your currently owned dogs primarily kept? *

Check all that applies:I do not currently own a dogHouseGarageKennelBackyardOther

Have you previously owned any pets? *

YesNo

If Yes, Please provide info about previous pets:

Please list info on each pet 1. Type of Pet 2. Breed & Age 2. Were they spayed/Neutered 3. How long did you have them 4. What happened to them

Who will responsible for the daily care and health of your adopted dog? *

How Often will the dog be fed? *

Once a DayTwice a DayThree Times a DayI don't KnowOther

If other: Please Explain

What will the dog be fed? *

Describe Dry Food, Wet Food, People Food, and Type of Food.

Where will your adopted dog be kept during the day? *

Be specific please. Inside, Outside, Garage. or actual location. Also what will they sleep in?

Where will your adopted dog be kept at night? *

Be specific please. Inside, Outside, Garage. or actual location. Also what will they sleep in?

Are you willing to _________ with your adopted dog? *

Check all that apply:Crate TrainEnroll in Obediance ClassesDo Obediance TrainingPotty TrainNone of the Above

Will you be crate training your dog? *

NoYes - To potty trainYes - While out running errandsYes - While at workYes - to sleep overnightYes - but for other reasons

How much time will your adopted dog spend in the house with your family each day? *

How will your adopted dog get exercise each day? *

How will you socialize the dog? *

I do not plan to socialize the dog other then at home with my familyDog parkPlay dates with other dogsOther: Please explain in the next box

If you will socialize your dog in other ways please specify:

How long are you willing to give your adopted dog for an adjustment period? *

What will you do if your adopted dog begins to exhibit bad behaviors?

Also describe how you will discipline your dog if he/she was misbehaving.

Can you financially afford to provide healthcare for your adopted dog in a timly manner if he/she were to get sick or injured? *

YesNoI don't know

Will you return your adopted dog to Under the Angel's Wings Rescue if you can no longer keep him/her or care for him/her for any reason? *

YesNoI Don't Know/Not Sure

Will you allow Under the Angel's Wings Rescue to visit for a home check prior to adopting a dog? *

YesNoI don't know/Not Sure

If Yes, When is the best time to contact you and when would be a good time to visit your home?

If No, Please explain

In the past have you ever been forced to give up a dog? *

(Please check all the apply)NoYes - Gave the dog to a relativeYes - Gave the dog to a rescue groupYes - Gave the dog to a friendYes - Gave the dog to some thru newspaper, craigslist, or similarYes - Other

If Yes-Other Please Explain:

Under what circumstances would you feel you need to give up your dog? *

(Please check all that apply)MovingNew BabyPeople IllnessExcessive vet billsDog too hyperNot getting along with other petsAllergiesNot Bonding with me or my familyI do not have time for the dogExcessive sheddingDigging up Garden/YardDestructive ChewingDog nips/bites kidDog nips/bites strangersDog develops chronic illnessDog barks too muchHouse Training ProblemsNone of the aboveOther reason not listed.

If you chose other:

I would have to give up the dog if:

References *

Please provide your Veterinarian Name and Phone Number along with (2) other references such as groomer, dog walker/sitter, friend, etc

Are you ready for the emotional and financial responsibility of adding a dog into your life? *

YesNoI think soI don't know

Other notes or comments you would like to add for our consideration.

*My e-signature below certifies that I am at least 21 years of age and I certify that all the information contained herein is true and correct. I also understand that any false information given will nullify this application. *I understand a dog can live 10 to 15 years and I am prepared to make a commitment to feed, shelter, and care for my pet for the rest of his/her life.

Type your Signature Below: *You agree this is your legal & binding signature and confirms that you have read and agreed to all of the above.

Today's Date *

Canine Adoption Application

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