Canine Crusaders of New Jersey

Canine Crusaders of New Jersey Dog Adoption Application

Thank you for your interest in adopting a dog rescued by CANINE CRUSADERS LLC.(Of New Jersey). We want to make certain that every animal adopted goes to a loving home where it will be well cared for. Our application asks a number of detailed questions which are necessary for our screening process..

All information will be kept confidential. If you have any questions, please call Ed at (908) 310-6513 or Ellen at (732) 715-3909

Please allow up to a week for processing your application. Thank you!

Your full name______

Home Address______

City______State______Zip______

Home Telephone______Cell______

E-Mail______Age______

Place of Employment______Phone______

Spouse or partner’s name______

Spouse or partner’s work number______

About your home:

Type of Residence ______

Do You: own rent live with parents other:______

Name of landlord______Phone number______

How long have you lived at this residence ______

About your family: How many adults live in the house_____ Children___ Age of Children______

Are all members of the family in agreement about adopting a dog______

Is anyone in your house nervous or unsure around dogs______

Do you have many young visitors ______

Who would this dog belong to______

Plans for your new pet:

Where will you new dog live: indoor outdoor indoor most/outdoor some

Do you have a fenced yard______Dog run______Dog house______

Name number and address of your Vet ______

Will you have the dog Spay/Neutered______When______

Please list all other pets on the house

Will you provide health care on a regular basis for your new pet______

Can you provide a home for this dog for the rest of its life______

You agree to allow Canine Crusaders to call your vet and follow up as needed______

______References:

Please list 3 References (all references will be checked) name address and phone number.

1) ______

2) ______

3) ______

Pet History:

Have you ever owned a dog______how many______how many now_____

As all your family in the house lived with dogs______

Have you ever given a pet away______had one hit by a car______

Have you ever lost a pet______had one stolen______

Have you ever had a pet removed from your care______

Please list pets you have had in the past 10 years______

Preferences:

I prefer a dog that is small medium large X-large any size

Reason for adopting this dog______

Energy level preferred High medium low

How will you exercise this dog______Would you be willing to have a home visit from CCLLC and a follow up home visit in the first 6 month of adoption______

By clicking the Submit button below, I certify that:

o The information I have given is accurate o I understand that Canine Crusaders has the right to deny any application o I give permission for a representative of Canine Crusader to call the references and veterinary practices I have listed. o

Sign Here Date Print Name

Please Sign______Print Name______