Changing lives... One tail at a time

A New Chance Animal Rescue Application to Adopt a Dog

Dogs for adoption

Adoption process

adoption@anewchancear.org

Please Donate!

Before filling out the application, please read this information carefully and check each line that you agree.

I understand that vet care for my adopted dog can cost over $1,000 per year.

Depending upon the particular animal, dogs can live to be as old as 17 years of age. I understand this and am comitted to care for my adopted dog for the length of his/her life.

I understand that there is an adoption donation of $250 - $450 and agree to pay that donation.

I verify that everyone living in my home is in agreement to adopt a dog at this time.

I am 21 years of age or older.

I understand that the information in my application to A New Chance Animal Rescue is confidential.

I understand that A New Chance Animal Rescue has the right to decline my application.

I am ready to adopt within 7 - 10 days of filing this application. If not, please do not apply until that time.

Applicant Information

First name
Last name
Address
E-mail
Home phone
Cell phone

Employment Information

Spouse's Employment Information

Name Name
Occupation Occupation
Employer Employer
Address Address
Work phone Work phone
Work hours Work hours
Time you leave Time you leave
Time you return Time you return

Home Information

Type of home Rent Own Are dogs permitted?
Size/Breed limits?
Landlord name Phone number
Landlord address
How long have you lived at this address?
Plans to move? Please explain:
Describe the home's yard
Fenced Type Height Fully enclosed
Please describe your home's setting:

Household Information

Family members
Name Age Allergies
Additional info / Comments
Name Age Allergies
Add. info
Name Age Allergies
Add. info
Name Age Allergies
Add. info
Name Age Allergies
Add. info
If you have additional family members, please add here

Pet Information

Other pets living in your home:
Type Name Age Altered?
Additional info (where it's from, its personality, how it gets along with other animals, etc.)
Type Name Age Altered?
Add. info
Type Name Age Altered?
Add. info
Type Name Age Altered?
Add. info
Type Name Age Altered?
Add. info
If you have additional pets, please add here
As an adult, have you owned a dog or cat before that is not listed? What happened?
As an adult, have you taken a dog to a shelter? Please explain:
Are there any family trips planned? Please explain:
Where will the dog be kept when you are at work or out?
Where will the dog sleep?
How will the dog be exercised?
Where will the dog relieve itself?
What type of dog are you hoping to adopt?
Age? Size? Gender?
Please provide two personal references that are not related to you
Name Cell phone Home phone Relationship
Name Cell phone Home phone Relationship
Veterinarian reference
Name Phone Address
Additional information you would like us to know:

Your application will not be processed unless it is complete.