<p> Izzy’s Place Senior Dog Rescue Adoption Application</p><p>Thank you for your interest in adopting a dog from Izzy’s Place! We are solely dedicated to dogs aged six years and older. Some are active; some are calm; some have special needs; and others are ready for a good, long run. We hope to find the right home for each dog, and the right match for your lifestyle too.</p><p>It may take up to two weeks to process your application. We are a 100%-volunteer organization, and most of us have full-time jobs, families, and dogs of our own; so we appreciate your patience. Our process is thorough because we care. If we do not contact you within two weeks of receiving your application, please call us (970-541- 0443).</p><p>Today’s Date: ______</p><p>ADOPTABLE DOG INFORMATION (Behavior and Health):</p><p>Please list the Name and, if you know it, Tag Number of any dogs you are particularly interested in, if applicable:</p><p>______</p><p>Please list any breed/mixes, age, activity level, etc. that you might be interested in (Sadly, we turn away senior dogs each day because of lack of resources. If there is a specific breed, size, personality, etc. you are looking for, we can help you find it.):</p><p>______</p><p>______</p><p>BASIC INFORMATION:</p><p>Applicant’s Name: ______Co-Applicant’s Name: ______</p><p>Phone (Primary): ______Phone (Secondary): ______</p><p>Address: ______</p><p>City: ______State: ______Zip: ______</p><p>Email: ______How did you hear about Izzy’s Place? ______</p><p>Please list everyone living in your household:</p><p>Name (First and Last) Age Relationship to Applicant</p><p>P a g e 1 | 5 Form last updated: 7/1/2016 Izzy’s Place Senior Dog Rescue Adoption Application HOUSEHOLD INFORMATION:</p><p>How long have you lived at this residence? ______</p><p>Do you own or rent? Own or Rent (circle). Renters must provide either a copy of the lease showing the applicable pet policy or a letter from the landlord stating you are allowed to have the type of dog you are applying to adopt.</p><p>Do you have stairs inside your home? ___Yes or ___No. If Yes, please describe in detail:</p><p>______</p><p>Do you have stairs leading inside/outside? ___Yes or ___No. If Yes, please describe in detail:</p><p>______</p><p>Do you have hardwood floors? ___Yes or ___No. Rugs? ___Yes or ___No. Tile? ___Yes or ___No. How will you accommodate a dog who is not comfortable walking on hardwood or tile floors?</p><p>______</p><p>Your newly adopted dog might have accidents during the transition period. How will you handle that?</p><p>______</p><p>Is everyone in your house aware of, and on board with, your intentions to adopt a dog? ___Yes or ___No. If not, please explain in detail: ______</p><p>______</p><p>Does anyone in the household have known pet allergies? ___Yes or ___No. If Yes, please describe in detail:</p><p>______</p><p>Does anyone in the household have a fear of dogs? ___Yes or ___No. If Yes, please explain (large dogs, specific breeds, or colors): ______</p><p>______</p><p>Please list all pets and their specifics who currently live in your household:</p><p>Species Breed Name Age Gender Spayed/Neutered?</p><p>P a g e 2 | 5 Form last updated: 7/1/2016 Izzy’s Place Senior Dog Rescue Adoption Application</p><p>If you have dogs, please explain what type of dog the existing dog(s) get along with best (i.e., male/female, large/small, playful/calm, etc.): </p><p>______</p><p>Do you have cats? ___Yes or ___No. If so, are they used to being around dogs? ___Yes, ___No, ___Unknown. </p><p>If you have cats, do you have a room or an area where either the cats or the new dog can stay until they’re all used to each other? ___Yes or ___No. If No, please explain how you will accommodate the new dog or the existing cats until they all get used to each other:</p><p>______</p><p>Do you have other small pets? ___Yes or ___No.</p><p>If you have other small pets, are they allowed free roam of the house? ___Yes or ___No. Do they have a cage, kennel, or some other safe area they can be in while adjusting to a new dog? ___Yes or ___No. If not, please explain how you will ensure the other small pets are kept separate from the new dog until they all get used to each other:</p><p>______</p><p>Do you have a fenced yard? ___Yes or ___No. If Yes, please provide height, type, and a brief description:</p><p>______</p><p>If you do not have a fenced yard, how do you plan to let your new dog out to potty and exercise?</p><p>______</p><p>Do you have a dog run? ___Yes or ___No. Do you tether your dog? ___Yes or ___No.</p><p>How many hours will the dog(s) be alone on a typical day? ______</p><p>Where do your (or would your) dog(s) stay when you are out running errands, working, etc.?</p><p>Where do your (or would your) dog(s) stay when you travel? ______</p><p>How do you (or would you) discipline your dog(s)? ______</p><p>______</p><p>Are you open to professional training for your new dog, if needed? ___Yes or ___No.</p><p>Do you already have a professional trainer? ___Yes or ___No.</p><p>P a g e 3 | 5 Form last updated: 7/1/2016 Izzy’s Place Senior Dog Rescue Adoption Application</p><p>Have you previously trained a dog yourself? ___Yes or ___No. If Yes, please explain: ______</p><p>______</p><p>______</p><p>Rescue dogs often experience a transition period when adopted. They may adjust easily, or they may be uneasy at first. Please explain how you will help your new dog transition to his/her new home:</p><p>______</p><p>______</p><p>Do you have experience with common senior ailments (i.e., arthritis, lumps and bumps, incontinence, etc.), which may require adjustments in the home and/or veterinary care? ___Yes or ___No. If Yes, please explain:</p><p>______</p><p>______</p><p>Dogs with special needs make great pets! Are you open to considering a dog who has any of the following? Separation Anxiety? ___Yes ___No Vision Impaired? ___Yes ___No Hearing Impaired? ___Yes ___No Tripod/Amputee? ___Yes ___No Diabetes? ___Yes ___No Epileptic/Seizures? ___Yes ___No Other? Explain: ______</p><p>Have you ever given up/surrendered a pet? ___Yes or ___No. If Yes, please explain:</p><p>______</p><p>______</p><p>Have you ever euthanized a pet? ___Yes or ___No. If Yes, please explain:</p><p>______</p><p>______</p><p>Senior dogs often need more frequent vet visits for common senior ailments—such as arthritis, incontinence, vision or hearing impairment, dental disease, etc., which means it can get expensive to take care of them properly. Are you financially able and willing to provide all necessary care for your senior dog? ___Yes or ___No. </p><p>P a g e 4 | 5 Form last updated: 7/1/2016 Izzy’s Place Senior Dog Rescue Adoption Application Please let us know why you want to adopt a senior dog and what you can provide for them:</p><p>______</p><p>______</p><p>______</p><p>VETERINARY REFERENCE:</p><p>Vet Clinic Name: ______Vet’s Name: ______Vet Clinic Address: ______Vet Clinic Phone: ______PERSONAL REFERENCES:</p><p>1. Name: ______Relationship: ______</p><p>Email: ______Phone #: ______</p><p>Address: ______</p><p>2. Name: ______Relationship: ______</p><p>Email: ______Phone #: ______</p><p>Address: ______</p><p>Applicant Name (please print): ______</p><p>Applicant Signature: ______</p><p>Date ______</p><p>This application is not a binding agreement. Applicant is under no obligation to adopt a dog, and Izzy’s Place is under no obligation to provide a dog to applicant. Dogs suggested to the applicant based on this application and the subsequent interview and home check may differ from dogs listed on this application, as Izzy’s Place may believe that different dogs are a better match for said applicant. Adoption fees range from $50 - $175.</p><p>You can either email or mail us this completed application. To email it, please use the following email address: [email protected] . To mail it, use this address: Izzy’s Place, 1151 Eagle Drive, #305, Loveland, CO 80537.</p><p>P a g e 5 | 5 Form last updated: 7/1/2016</p>