Papillon 911 Rescue and Adoption, Inc

Adoption Application This may seem like an excessively detailed, even invasive, questionnaire but please keep in mind that the more information we have about you, your household and your expectations of your rescued dog, the easier it will be to make a successful match. Finding the perfect match between adopter and dog is our most important goal. Please read the Adoption Guidelines before completing this application. Be aware that you must travel to the Foster Home to meet the dog and his Foster Family. We do not ship or deliver our precious Papillons.

NOTE: To fill out this form, just click on the light blue areas and begin typing your answer. Where it says “Select one” just click it and select your answer. You can use the tab key on your keyboard to move to the next field to be filled out. *Instructions for sending your completed form are at the bottom of this document.*

Where did you hear about PAP 911 Rescue? Member? Who? Friend? Who? Website? Petfinder.com Select one

Which Papillon are you interested in adopting? Is this the only Papillon you would be interested in? Select one

Contact Information Today’s Date: Name: Address: City, ST, ZIP

Birthday:

Phone Number Home: Work: Cell:

Email Address:

Papillon 911 Rescue and Adoption Adoption Application revised 9-13-09 Page 1 of 7 Papillon 911 Rescue and Adoption, Inc

How many adults in the household? Please list their names, ages and occupations including you: How many children in the household? Please list their names and ages: If no children in the home, do Select one grandchildren, nieces/nephews or other kids ever visit?

Who will be the primary caregiver for the new dog? Does this person work Select one away from the home? How many hours per day will the dog be left alone? Please explain.

How long at current address? Is it a house, condo, apartment or other? Select one If other please specify Do you own or rent? Select one If condo or apartment, what are the rules of pet ownership? (answer on next line)

If you rent, please provide the name and phone number of the property owner:

If you live in a condo, please provide the name and number of a condo representative:

Do you have a securely fenced yard? Select one If so, what type of fence is it Select one (wood, chain link, block wall, etc.)? If your fence is not a solid privacy fence, how much space is between pickets or boards? How high is it? Is there a doggie door leading to the yard? Select one If you do not have a fenced yard, where and how often do you plan to take your dog to potty? Will the dog be on a leash? Under what circumstances would you allow your dog to be off-leash?

Are there any areas of the house Select one where the dog will not be allowed? If so, how will you keep the dog out of them?

Will the dog be allowed on the furniture? Select one If not, how will you keep it off the furniture?

Will the dog be given the run of the Select one house when no one is at home? Please explain previous question Where will the dog sleep? Will you use a crate for your new dog? Select one

Have you ever trained a dog to respond to simple commands? Select one If so, how would you describe the method you used?

How will you discipline your new dog for undesirable behavior?

If your new dog is not housetrained, how will you housetrain it?

Are you aware that even housetrained dogs need a period Select one of adjustment in a new home? What will you do if the dog has “accidents” in the house?

How many dogs have you owned? How long did you have your last dog? Did you have the dog until it died? Select one If so, at what age did it die? How did this dog die? If not, what happened to it? Was it spayed/neutered? Select one

Can you tell us about some of your previous pets and what happened to them?

Do you currently have a dog(s)? Select one If so, please list their breed, age, sex, weight and whether they are spayed/neutered:

Where have your previous or current dogs mostly lived, indoors or outdoors? Select one Do you have any other pets or farm animals? If so, please list species:

If you have a cat(s), describe how you hope your new dog will interact with it:

How do you intend to exercise your new dog?

Do you have what you consider an active Select one lifestyle or are you more the couch potato type? Do you travel a lot? Select one

When you go out of town, what arrangements will you make for the care of your rescued dog?

Why do you want a dog (or another dog) at this time?

Why do you want a Papillon in particular?

Have you ever had a Papillon before? Select one Have you ever had a rescued dog before? Select one Why do you want a rescued dog?

What characteristics do you especially want in your new dog?

What characteristics do you not want in your new dog?

What will you do if your new dog has some unwanted characteristics?

What is the age range of the dog you hope to adopt? What sex and why?

How important to you is it that the dog already be housetrained? Select one Are you willing to adopt a special needs dog Select one (requires medication, deaf or blind, etc.)? Are you aware that Papillons can be big barkers? Select one What will you do if your rescued dog barks a lot?

Please provide the name and phone number of your current or previous veterinarian:

Please provide the names and phone numbers of three personal references, not including family members. (Please note that it may not be necessary to contact all three.):

Do you agree to have a representative of Papillon 911 Rescue Select one visit your home prior to adoption? Do you agree to a follow-up visit after adoption? Select one Do you agree to pay an adoption donation of $100-$450, Select one depending on the dog’s age, health and possible special needs? If anything were to happen to you that prohibits you from Select one keeping the dog, do you understand that a Papillon 911 Rescue must be notified and the dog must be returned to us?

Thank you for completing this application and thank you for wanting to give a forever home to one of our rescued Papillons! Applicant Signature Enter Date Your typed name is as binding as your signature.

Please fill out in full.

PAPILLON 911 Rescue and Adoption, INC Foster/Adoption applicant authorization and written release.

This form authorizes the Pap 911 organization to obtain information and also authorizes release of information from service providers and references to determine if the applicant may adopt or foster for our organization.

I, currently residing at City State Zip

Hereby give permission to release information or records in order for me to foster/adoption of a dog from Pap 911.

All information requested will only pertain to fostering or the adoption of a dog. All information will be kept confidential used solely for adoption/fostering of a dog.

I understand that:

That Pap 911 is only seeking information for me to become approved to foster or adoption of a dog.

I may or may not be eligible for adoption/fostering under Pap 911's guidelines.

The permission that is hereby granted shall expire (1) one year from the date below.

Signed Date Your typed name is as binding as your signature.

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Papillon 911 Rescue and Adoption Adoption Application revised 9-13-09 Page 7 of 7