Kanyon’s Gold Rescue Adoption Application page 1
PLEASE PRINT ALL INFORMATION
First Name: ________________________________________________
Last Name: _________________________________________________
Co-Applicant: ______________________________________________
Street Address: _______________________________________________________________________________
City: ___________________________________________________ State: __________________ Zip:______________________
Home Phone: __________________ Work Phone:______________________
Best Time(s) to contact: _________________________
Email Address ______________________________________________________________________________________
A complete answer to the following questions will enable us to be more familiar with your request and requirements and will help us find the Rescue dog to match your needs and expectations.
**** GENERAL QUESTIONS ***
How did you hear about Kanyon’s Gold Rescue? ______________________________________________________________________
Do all family members want a rescue dog? Yes / No
Are you willing to come here to pickup your Rescue dog? Yes / No
*** INFORMATION ABOUT YOUR HOUSEHOLD ***
Please list all the members of your household with their ages, including your pets:
Humans, Names & Ages: ______________________________________________________________________________________
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Dog(s), Name, Age, Breed, Gender, Altered?, What happened to pet?:
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Cats, Age, Altered?, What happened to pet?:
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Other Pet Types, Type, Age, what happened to pet? :
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Adoption Application : Kanyon’s Gold Rescue page 2
If you do not have small children living in your home, will your Rescue Dog come into regular contact with any children under the
age of 10? Yes / No
If yes, how often and what ages? ________________________________________________________________________________
If you do not have a dog now, have you ever owned a dog for whom you were the primary caretaker? Yes / No
If Yes, what happened to the dog? ______________________________________________________________________________________
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Does anyone in your house have allergies? Yes / No
If Yes, what kind of allergies? ____________________________________________________________________________________
Do you own or rent your home? Own / Rent
How long at current residence:____________________________________________________________________________
If you rent, has your landlord provided written permission for you to have a large dog? Yes / No
Please provide your landlord’s name & phone #: _____________________________________________________________________
Do you have a fenced yard? Yes / No
If yes, please describe the fence: Type: ____________________________ Width: ________
Length: ________ Height: _________
If you don't have a fence, are you willing to install one? Yes / No
*** INFORMATION ON THE CARE OF YOUR DOG ***
Who will care for, train and exercise the Rescue dog? ______________________________________________________________________________________
Who is the Rescue dog primarily for? ______________________________________________________________________________________
Who is your Veterinarian? ______________________________________________________________________________________
Vet’s phone number & address : ______________________________________________________________________________________
Why do you want a Rescue dog? ______________________________________________________________________________________
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Adoption Application : Kanyon’s Gold Rescue page 3
How will you exercise your Rescue Dog?
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Where will your Rescue Dog be kept during the day? ______________________________________________________________________________________
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How many hours per day will your dog(s) be alone (without humans) on a regular basis? ________________________________
Will the dog(s) be allowed in the house? Yes / No
Will the dog(s) have the run of the house? Yes / No
Are you familiar with the use of a dog crate to train and/or confine the pet during your absence or at night? Yes / No
Are you willing to use a crate? Yes / No
Will the dog(s) be in blocked-off parts of the house? Yes / No
Will the dog(s) be tied outside? Yes / No
Will the dog(s) live in the yard? Yes / No
Will the dog(s) be walked daily? Yes / No
Will the dog(s) be exercised in a fenced yard? Yes / No
Will the dog(s) be allowed to run free outside of a fenced yard? Yes / No
It is strongly recommended that to build a bond with your new dog and establish the ground rules in your family that you enroll in a positive reward-based training class after your dog has settled into your home.
Would you like a referral to such a class in your area?
Yes / No
Will your dog(s) receive formal obedience training? Yes / No
If Yes, please identify the obedience trainer : ______________________________________________________________________________________
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When you move, what will you do with your dog(s) (and/or other pets)? ______________________________________________________________________________________
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Why do you think you would be a good adopter for rescue dog(s)? ______________________________________________________________________________________
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Adoption Application : Kanyon’s Gold Rescue page 4
*** MISCELLANEOUS QUESTIONS ***
May we visit your home prior to application approval? Yes / No
If Yes, when? ________________________________________________________________________
Are you aware that Rescue dogs are active and shed all year long? Yes / No
Will you groom your dog or use a groomer? ____________________________________________
Are you aware that routine costs of maintaining a dog can average $500 a year (for food, shots, checkups, heartworm & flea prevention, grooming, etc)? Yes / No
Have you sold, given away, or surrendered a pet to a shelter, pound or Humane Society? Yes / No
If Yes, please provide details? _____________________________________________________
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Do you understand the state and local ordinances concerning licensing? Yes / No
Leashing? Yes / No
Have you or any member of your family/household been cited for leash law violations or animal cruelty?
Yes / No
If Yes, please provide details? __________________________________________________________
Have you applied to any other Rescue Groups? Yes / No
If Yes, please identify the group(s) so that we do not duplicate their effort(s): ______________________________________________
*** PREFERENCE QUESTIONS ***
Age preference(s): ___________________________________________________________________
Color preference: Light / Medium / Dark Size: Small / Medium / Large
Activity preference: Low / Medium / High Sex Preference: Female / Male (all are spayed/neutered)
Breed or Mix Preference (if any): ____________________________________________________
Purpose of obtaining dog: ____________________________________________________________
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Would you consider a Special-Needs Dog such as one who requires medication for a permanent buy controllable condition? Yes / No
Any Additional Comments? ____________________________________________________________
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*** AGREEMENT ***
I/We attest that the Terms and Conditions of Adoption as stated with the Contract have been read in full by me/us and I/we understand
that this is part of the adoption process 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 we have retained a copy of the Terms and Conditions of Adoption and also
understand that completion and submission of this application does not guarantee adoption of a Rescue dog.
Applicant’s signature: ______________________________________________
Co-Applicant’s signature: __________________________________________
Date: _______________________
