Please answer all questions. If the question does not apply, enter N/A.
Your Name (Please enter your name without ANY periods or commas):
Names and relationship of all other Adults in home (spouse, adult child, roommate, etc):
Name of Dog you are interested in:
City: State: Zip:
Home Phone with Area Code:
Names and Ages of all minor children in home: Names and ages of all children in home:
What type of home do you live in: (ex. House, condo, apartment)
Do you own or rent?
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 CANNOT be left outdoors alone for long periods unsupervised. Do you agree to this condition? Yes
Are you willing to keep a collar with a tag bearing your contact information on your dog at all times? Yes No
Have you ever owned a dog? Yes No
List all pets you have owned in the past 5 years:
Please give the following information about all animals you currently own:
Are all pets currently in your home spayed or neutered? Yes No
Are all pets currently in your home up to date on all immunizations? Yes No
Brand of heartworm preventative you use (or used with previous pets):
Where do you (or did you) purchase the heartworm preventative?
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?
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?
For what reason would you consider giving up a pet?
How would you describe your household activity level? Quiet Moderate Active
Estimate the number of times per month children visit your home:
What age or ages are the children?
In addition to a regular life at home, would your dog:
Walk routinely with a family member?
Go to obedience classes?
Go to your place of business with you?
Travel with you?
Be a playmate for your children or pets?
Would you prefer a male or female? Male Female Either
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? (There is information about crate training on our website under the “useful information” tab) 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
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?
Do you have a backup plan in the event you should predecease your dog or become physically incapable of caring for it?
Please list your veterinarian's name, address and phone number:
PLEASE NOTE: We will do a reference check asking if your current or recently owned pets are or were altered, kept up to date on immunizations, and on heartworm and flea preventative. Please list the vet who can give us this information, even if it is NOT the vet you plan to use or have recently begun using. Some vets require your authorization before they will release this information to us. It will speed the application process if you will call the vet’s office and authorize them to talk to us. Please be sure to give us the 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.
If this would be a long distance adoption, please indicate how you would be able to get your new family member home. PLEASE NOTE: We do not ship or transport our dogs.
Are you or your spouse in the military? Yes No
If yes, is there a possibility of deployment? Yes No
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.