Application If you Rent: are there any dog breeds that you are prohibited from having? Name of the dog you are interested in * Name of the person who will be responsible for the animal * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone (###) ### #### Work Phone (###) ### #### Cell Phone * (###) ### #### Preferred method of contact * Do you Own or Rent - Own Rent If you Rent: How long have you lived at this address? If you Rent: Any plans to move in the near future? If you Rent: Landlord's Name: If you Rent: Landlord's Phone Number (###) ### #### Number of adult in the household: Relationships Have all adults in the household agreed to this adoption? Number of children in then household: Ages of children: Have children had pets before? Do you expect your family situation to change? - Yes No Is anyone in the household allergic to pets? - Yes No Is anyone allergic to pets? If yes, who Occupation Employer Position Held Work Address Address 1 Address 2 City State/Province Zip/Postal Code Country How long have you been with this employer? How many pets do you currently have, please list age, sex, and breed (for dogs). Have you had pets in the past? If yes, please list their species and why they are no longer with you? Have you ever given an animal away or relinquished to an animal shelter? if yes, what were the circumstances. If applicable, Veterinarians Name, Phone number, and when was your pet's last visit and why? How did you hear about our rescue? (e.g. internet search, nextdoor, petfinder, referral)? How long have you been looking for a pet Describe the dog you would like to adopt, preferred age. Would you be willing to accept one that isn't housebroken yet? Yes No Would you be willing to accept and care for one with health problems? Yes No Would you be willing to accept and work with one with behavior problems? Yes No How much time are you prepared to allow for your new pet to adjust to your home? Are you able to afford a bill of up to $5000 for emergency veterinary care (please note that any hospitalization typically generates a bill over $1000)? - Yes No Are you committed to providing a responsible home for your pet’s entire life (15+ years)? Yes No If you have to move, what do you plan to do with your pet(s)? Who in the household will be the primary care giver? When you are out of town or during an emergency, who will be the dog’s primary care giver? Where will the dog be kept during the day and night How many times per day do you plan to take your dog outside? Do you have a fenced yard? If so what size? How many hours per day will the dog be left alone? Explain what you would do if your dog develops a problem with the following? a) Barking b) Separation Anxiety c) Aggression Describe how you would handle housebreaking your dog: Describe how you would deal with a dog that chews: Why do you want to adopt a dog? Please describe what the dog’s typical day will be like: Will you allow your pet up on furniture (chair, couch, bed) or do you need a dog that is trained NOT to go up there? What are some attributes that you like about this breed? Are there characteristics that concern you about this breed? What methods will you use to keep your dog safe and sound? If looking to adopt a puppy, why a puppy? Are you familiar with the care and training required for a puppy, and what steps will you take to prepare for that responsibility? Will you take the puppy to training classes? - Yes No Please list 2 personal references below (name, relationship, and phone number). Adoption Applicant Signature * the Kern Project makes every effort to communicate breed, age, health and behavior information about each rescue animal accurately. However, our staff and volunteers are not animal experts, and we do not conduct our own health and behavior evaluations upon receiving an animal from the shelter. We rely almost entirely on the evaluations conducted at shelters, which may or may not be done by professionals. As a result, we require adopting families to release us of all liability resulting from any wrong or incomplete information, including but not limited to breed, age, health, and potential behavior problems. Adopting families must also assume all risks associated with introducing their rescue animals to third parties. We recommend that new families wait until they have become very familiar with their new pet and its temperament before attempting any introductions to people or animals outside of their immediate family. By signing below, I certify that the information I have given is true. I authorize the investigation of all statements in this application. I understand that the Kern Project reserves the right to deny my application for any reason. I also agree to abide by all of the policies of the Kern Project, specified above. I understand that while the Kern Project makes every effort to communicate to new families the breed and age of their dog as well as any behavior or medical problems that they are aware of, they do not make any representation or guarantee about the behavior, health, breed or age of any rescue dog. Adopters accept all liability for their new pets. First Name Last Name Date MM DD YYYY Thank you!