Adoption Application

Please answer all questions. If the question does not apply, enter N/A.

Date of Application: 

Your Name: 

Age: 

Names of all other Adults in home: 

Email Address: 

Name of Dog you are interested in: 

Address: 

City:       State:       Zip: 

Home Phone with Area Code: 

Work Phone: 

Number of children in Home: 

Ages of children: 

What type of home do you live in: (ex.  House, condo, apartment) 

Do you own?  Rent?  Lease? 

If you rent or lease, you will be required to have written permission from your landlord. Landlord's name and telephone number is:

Is your yard fenced?  Yes    No

If yes, please describe the type of fencing, area fenced and height:

Do you have a swimming pool?  Yes    No      In ground?  Yes, in ground

If In Ground, is it separately fenced from the rest of the yard?  Yes    No

Are you willing and able to modify your schedule to accommodate a dog's needs, such as going outdoors into a fenced area or walking on a leash to perform bodily functions at least 4 times a day?  Yes    No

Do you agree to keep the dog on a leash or in a fenced area when it goes outside? 
Yes    No

Our dogs are primarily housedogs.  They can be kept outdoors for short times, in a kennel or doghouse with an attached run. Or they can use a doggie door to go in and out.  They CANNOT be chained, tied outdoors or left outdoors alone for long periods unsupervised.  Do you agree to these conditions?  Yes    No

Do you know if there are local ordinance in your area pertaining to owning/housing an animal (i.e. leash laws, required vaccinations, dog licenses, etc)?  Yes    No

Are you willing to keep a collar with a tag bearing your name, address, phone number, etc. on your dog at all times?  Yes    No

If for any reason, you are unable to keep your dog, will you agree to return it to Little Bits Rescue & Adoption?  Yes    No

Are you willing and able to accept full care, costs, and necessary burdens and responsibility of owning a pet?  Yes    No

Have you ever owned a dog?  Yes    No

List all pets you have owned in the past 5 years:

Please list type of pet, sex, age, if altered and if current on vaccinations of all animals you currently own:

Have you ever sold, given away or sent a pet to a shelter?  Yes    No

If you answer YES, please explain:

Will someone be home during the day with your dog?  Yes    No

Would you consider using a doggie door to allow your dog access to your fenced yard?  Yes    No

 How many hours will your dog be left alone? 

Where will your dog be kept when left alone? 

Where will your dog be kept when you are home? 

Where will your dog sleep at night? 

What are your feelings about allowing your dog on your furniture, i.e. couch, armchair?

Who will be responsible for the feeding, grooming and training of your dog?

What would be the reason you would give up a pet?

How would you describe your household activity level?

Estimate the number of times per month children (under 12) visit your home: 

In addition to a regular life at home, would your dog:

Would you prefer a male or female?  Male    Female

What age would you prefer?  Keep in mind it is rare to have puppies in rescue.

What personality traits are important to you in your dog?

What personality traits would you NOT want in your dog?

Would you accept a dog that has been physically or emotionally abused?  Yes    No   Maybe

Would you accept a dog that has a minor health problem?  Yes    No    Maybe

Will you work with your dog if it is not quite housetrained?  Accidents are expected when the dogs change homes/schedules.  Yes    No

Are you familiar with crate training as a house training method?  Yes    No

Would you be interested in learning about crate training?  Yes    No

Are you willing to give your dog adequate time to adjust to a new home?  Two weeks is the average amount of time it takes a dog to fully adjust.  Yes    No

Many breeds of dogs need to be professionally groomed on a fairly regular basis - about every 6 to 8 weeks.  Are you willing to do this, if needed?  Yes    No

Are you committed to caring for a dog for its life expectance of approximately 14 years, including all medical bills that might occur?  Yes    No

What if there is an emergency that will incur large vet bills?

Please list your veterinarian's name, address and phone number:

Please list 3 additional personal references (neighbors, coworkers, etc).  Please include relation to you, phone number with area code, and email address if possible.

Are you or your spouse in the military?  Yes    No

If this would be a long distance adoption, how would you get your new family member home? 

Additional comments:

By submission of this application, I/We unequivocally state that all statements and answers given in said application are the complete truth.  Any misrepresentation of the truth in this application will invalidate any subsequent adoption agreement and will give Little Bits Rescue & Adoption the right to reclaim the adopted dog without refund of the adoption donation.

All dogs adopted will be spayed or neutered.