Adoption Application

Step 1 of 10

Thank you for your interest in adopting a dog rescued by A New Chance Animal Rescue. We want to make sure that every dog that we place goes to a loving and appropriate home where they will be well cared for. Because of this, we require all applicants to complete a number of detailed questions necessary for our screening process.

This application must be completed in full in order to be processed. Please allow at least 30 minutes to ensure that it is complete. All information will be kept confidential.

Please note: We do not currently adopt dogs beyond a 90-mile radius of Bedford Hills, New York. If you are uncertain if you qualify, please go to Google Maps to verify that you are eligible to adopt BEFORE you complete this application.

Your Household
How many adults live in your household?*
Adult 1
Name:*
Age:*
Are you employed?*
Occupation:*
Employer:*
Employer address:*
Street Address City State ZIP Code
Work phone (include area code):*
Work hours:*
Time you leave for work:*
Time you return from work:*
I attend:*
- Full-time
- Part-time
In what state do you attend school?*
When do you graduate?*
How many hours a week do you devote to school (include class time, studying, commute, school activities)?*
Adult 2
Adult 2 name:*
Adult 2 age:*
Adult 2 relationship to applicant:*
Is Adult 2 employed?*
Adult 2 occupation:*
Adult 2 employer name:*
Adult 2 employer address:*
Street Address City State ZIP Code
Adult 2 work phone (include area code):*
Adult 2 work hours:*
Time Adult 2 leaves for work*
Time Adult 2 returns from work:*
Adult 2 attends:*
- Full-time
- Part-time
In what state does Adult 2 attend school?*
When does Adult 2 graduate?*
How many hours does Adult 2 devote to school (include class time, studying, commute, student activities)?*
Adult 3
Adult 3 name:*
Adult 3 age:*
Adult 3 relationship to applicant:*
Is Adult 3 employed?*
Adult 3 occupation?*
Adult 3 employer:*
Adult 3 employer address:*
Street Address City State ZIP Code
Adult 3 work hours:*
Adult 3 work phone (include area code):*
Time Adult 3 leaves for work:*
Time Adult 3 returns from work:*
Adult 3 attends school:*
- Full-time
- Part-time
In what state does Adult 3 attend school?*
When does Adult 3 graduate?*
How many hours a week does Adult 3 devote to school (include class time, studying, commute, student activities)?*
Adult 4
Adult 4 name:*
Adult 4 age:*
Adult 4 relationship to the applicant:*
Is Adult 4 employed?*
Adult 4 occupation:*
Adult 4 employer:*
Adult 4 employer address*
Street Address City State ZIP Code
Adult 4 work phone (include area code):*
Adult 4 work hours:*
Time Adult 4 leaves for work:*
TIme Adult 4 returns from work:*
Adult 4 attends school:*
- Full-time
- Part-time
In what state does Adult 4 attend school?*
When does Adult 4 graduate?*
How many hours a week does Adult 4 devote to school (include class time, studying, commute, school activities)?*
More than Four Adults in Household
Please list additional adults not mentioned above:
How many children live in your household?*
Age of first child:*
Gender of first child:*
Age of second child:*
Gender of second child:*
Age of third child:*
Gender of third child:*
Age of fourth child:*
Gender of fourth child:*
Age of fifth child:*
Gender of fifth child:*
Age of sixth child:*
Gender of sixth child:*
Do any children regularly visit your household?*
If yes, please describe ages of children and visit frequency.*
Do you regularly take care of any dogs that you do not own?*
If yes, please explain frequency of care and include dog type, age, gender, personality, and size of each dog you regularly care for:*
Are all members of your household in agreement about adopting a dog?*
Is anyone in your household nervous or unsure around dogs?*
If yes, please explain:*
For whom would you be adopting the dog?*
Who will be the primary caregiver for this dog?*
Who will be financially responsible for this dog?*
Are all members of your household willing and able to come to the foster home to meet the dog in which you are interested?*
If no, please explain:*
Do any members of your household have asthma or are allergic to dogs?*
If yes, who?*
Please explain the severity of their dog allergy:*
Are they taking medications for their allergy?*
Please describe your household activity/noise level:*
How often does the primary caregiver travel away from home?*
How many hours would your dog be alone during the day? (Please consider the time you leave for work, what time you return home, errands, after-school activities, etc.)*
Are any household trips planned in the next 6 months?*
If yes, how many trips are planned and for how long?*
How will you care for your dog when you are away from home? Who will provide the care?*
In the event of a short-term (up to one week) emergency, who would care for your dog and what arrangements would be made?*
In the event of a long-term (up to 3 months) emergency, who would care for your dog and what arrangements would be made?*
In the event of the death of the primary caretaker, who would care for your dog and what arrangements would be made?*

Your Current Pets
Do you currently own any other animals (excluding fish)?*
Please indicate the type of animal you have (check all that apply):*
- Dog
- Cat
- Bird
- Small mammal
- Reptile and/or amphibian
- Chicken
- Sheep
- Horse
- Other
Currently owning one or more dogs
How many dogs do you currently own?*
First Dog
Name of dog one:*
Breed of dog one:*
Size of dog one (lbs.):*
Age of dog one:*
Gender of dog one:*
Is dog one spayed or neutered?*
If dog one is not spayed or neutered, please explain:*
How long have you owned dog one?*
Please describe the personality of dog one:*
Does dog one get along with other dogs?*
If no or not sure, please explain (dog one):*
Are you experiencing any difficulties with dog one in terms of health or behavior?*
If yes, please explain:*
Second Dog
Name of dog two:*
Breed of dog two:*
Size of dog two (lbs.):*
Age of dog two:*
Gender of dog two:*
Is dog two spayed or neutered?*
If dog two is not spayed or neutered, please explain:*
How long have you owned dog two?*
Please describe the personality of dog two:*
Does dog two get along with other dogs?*
If no or not sure, please explain (dog two):*
Are you experiencing any difficulties with dog two in terms of health or behavior?*
If yes, please explain (dog two):*
Third Dog
Name of dog three:*
Breed of dog three:*
Size of dog three (lbs.):*
Age of dog three:*
Gender of dog three:*
Is dog three spayed or neutered?:
If dog three is not spayed or neutered, please explain:*
How long have you owned dog three?*
Please describe the personality of dog three:*
Does dog three get along with other dogs?*
If no or not sure, please explain:*
Are you experiencing any difficulties with dog three in terms of health or behavior?*
If yes, please explain:*
Do you own more than 3 dogs?*
If yes, name and describe each of your additional dogs:*
Canine Veterinary Care
Canine veterinarian name:*
Canine veterinary practice:*
Canine veterinary address:*
Street Address City State ZIP Code
Canine veterinary phone (include area code):*
Do you use the same canine vet for sick care and routine care (vaccinations, annual checkup)?*
If no, please provide the canine vet's name, the services they provide and a phone number:*
Do you use any other canine vets or vet specialists?*
If yes, please provide vet's name, services they provide and a telephone number:*
Have you used another canine vet within the last 5 years?*
If yes, please provide the vet's name and phone number:*
Is your dog currently vaccinated for rabies?*
Do you use heartworm preventative on your dog(s)?*
What kind of heartworm preventative?*
How often do you give heartworm preventative?*
Do you use flea and tick preventative on your dog(s)?*
What kind of flea and tick preventative do you use?*
How often do you apply flea and tick preventative on your dog(s)?*
PLEASE NOTE: We check all vet references, vaccinations, and heartworm preventative treatment. Please do not go any further or apply if your vet will tell us that you do not follow appropriate protocol …
Currently Owning One or More Cats
How many cats do you own?*
First Cat
Name of cat one:*
Age of cat one:*
Gender of cat one:*
Please description cat one's personality:*
Does cat one get along with dogs?
If no or not sure, please explain (cat one):*
Second Cat
Name of cat two:*
Age of cat two:*
Gender of cat two:*
Please describe cat two's personality:*
Does cat two get along with dogs?*
If no or not sure, please explain:*
Third Cat
Name of cat three:*
Age of cat three:*
Gender of cat three:*
Please describe the personality of cat three:*
Does cat three get along with dogs?*
If no or not sure, please explain:*
More than three cats
Please describe the additional cats you own in the space provided:*
Feline Veterinary Care
Feline veterinary name:*
Feline veterinary practice:*
Feline vet address:*
Street Address City State ZIP Code
Feline vet phone (include area code):*
Currently owning one or more birds
How many birds do you own?*
What type of bird(s) do you own?*
Please describe the living arrangements for your bird(s):*
Currently owning reptile(s) and/or amphibian(s)
How many reptiles and/or amphibians do you own?*
What type of reptile(s) and/or amphibian(s) do you own?*
Please describe the living arrangements of your reptile(s) and/or amphibian(s):
Currenly owning small mammal(s)
How many small mammals (guinea pigs, mice, ferrets, etc) do you own?*
What type of small mammal(s) do you own?*
Please describe the living arrangements of your small mammals:*
Currently owning horse(s), sheep, and/or chicken(s)
How many horse, sheep, and/or chicken do you own?*
Please describe their living arrangements:*
Equine Veterinary Care
Equine veterinary name:*
Equine veterinary practice:*
Equine vet office:*
Street Address City State ZIP Code
Equine vet phone (include area code):*
Currently owning other types of animals
Please describe the other types of pets that you own and their living arrangements:*

Previous Dog Ownership and Experience
Has every member of your household been around dogs at some point in their life?*
If no or not sure, please explain:*
Have you had the experience of being a primary caregiver to a dog?*
Please describe the care and the length of care the you provided:*
Have you ever given a dog away, given it to a shelter or rescue group, returned it a breeder, given it to a friend or sold it?*
If yes, please explain:*
Have you ever had a dog for a short period of time and it did not work out?*
If yes, please explain:*
Have you ever had your dog lost or stolen?*
If yes, please explain:*
Have you ever had to retrieve your dog from a pound, shelter or animal control facility?*
If yes, please explain:*
Have you ever had your dog die as the result of being hit by a car, being poisoned or from unknown causes?*
If yes, please explain:*
Have you had a dog that gave birth?*
If yes, please explain:*
Have you ever adopted from A New Chance?*
Have you previously applied to adopt from A New Chance?*
Have you ever been denied a dog adoption?*
Who denied your dog adoption (check all that apply)*
- A New Chance Animal Rescue
- An animal shelter
- Other rescue groups
Please explain the reason for their denial:*
Dog Ownership History
Excluding the dogs you currently own, how many other dogs have you owned over the past 10 years?*
Dog One
Name of dog one:*
Species/breed of dog one:*
Was dog one spayed or neutered?*
Age of dog one during ownership:*
What happened to dog one?*
If dog one died, at what age? In what year did he/she die?*
Vet used for dog one:*
First Last
Vet phone for dog one (include area code):*
Dog Two
Name of dog two:*
Species/breed:*
Was dog two spayed or neutered?*
Age of dog two during ownership:*
What happened to dog two?*
If dog two died, at what age? In what year did he/she die?*
Vet used for dog two:*
First Last
Vet phone for dog two (include area code):*
Dog Three
Name of dog three*
Species/breed of dog three:*
Was dog three spayed/neutered?*
Age of dog three during ownership:*
What happened to dog three?*
If dog three died, at what age? In what year did he/she die?*
Vet used for dog three:*
First Last
Vet phone for dog three (include area code):*
Dog Four
Name of dog four:*
Species/breed of dog four:*
Was dog four spayed/neutered?*
Age of dog four during ownership:*
What happened to dog four?*
If dog four died, at what age? In what year did he/she die?*
Vet used for dog four:*
First Last
Vet phone for dog four (include area code):*
Four or more dogs owned over the last 10 years
Please provide names, species, ownership dates and vet used for each additional dog you have owned:*

Step 1 of 10

Before filling out your adoption application, you must acknowledge each of the following:

Adult 1

Adult 2

Adult 3

Adult 4

More than Four Adults in Household

Currently owning one or more dogs

First Dog

Second Dog

Third Dog

Canine Veterinary Care

Currently Owning One or More Cats

First Cat

Second Cat

Third Cat

More than three cats

Feline Veterinary Care

Currently owning one or more birds

Currently owning reptile(s) and/or amphibian(s)

Currenly owning small mammal(s)

Currently owning horse(s), sheep, and/or chicken(s)

Equine Veterinary Care

Currently owning other types of animals

Dog Ownership History

Dog One

Dog Two

Dog Three

Dog Four

Four or more dogs owned over the last 10 years

ABOUT

ADOPT

FOSTER

GET INVOLVED

TOP DOGS

Menu

Step 1 of 10

Before filling out your adoption application, you must acknowledge each of the following:

Adult 1

Adult 2

Adult 3

Adult 4

More than Four Adults in Household

Currently owning one or more dogs

First Dog

Second Dog

Third Dog

Canine Veterinary Care

Currently Owning One or More Cats

First Cat

Second Cat

Third Cat

More than three cats

Feline Veterinary Care

Currently owning one or more birds

Currently owning reptile(s) and/or amphibian(s)

Currenly owning small mammal(s)

Currently owning horse(s), sheep, and/or chicken(s)

Equine Veterinary Care

Currently owning other types of animals

Dog Ownership History

Dog One

Dog Two

Dog Three

Dog Four

Four or more dogs owned over the last 10 years

Footer

ABOUT

ADOPT

FOSTER

GET INVOLVED

TOP DOGS