Open Door Animal Sanctuary

Canine Preliminary Adoption Form

This questionnaire must be filled out by all persons interested in adopting a pet from our shelter. The information you provide will not be given to any other organization. It is our job to find permanent, responsible homes for as many of our animals as possible and at the same time to find the right pet for you. To do this, we need specific information from you. Thank you for visiting the Open Door Animal Sanctuary.

Adopter's Name*

Your Email*

Adopter's Age (Must be 21 to adopt)

Address

City

State

Zipcode

Home Phone

Work Phone

Cell Phone

Which dog/puppy are you interested in?

1. I live in a
HouseApartmentCondoTownhouseMobile Home

2. I OwnRentLive on CampusLive with Parent/Relative

If you live with a parent/relative, are they aware you are here?
YesNo

If you are renting your home, what is the name of your landlord? If you are living in a mobile home park, what is the name of it?
Name
Phone

3. How many times have you moved in the last 3 years?

Did your animals move with you?
YesNo

4. Number of children at home

Children's Ages

Have they been around animals before?
YesNo

5. For what purpose are you adopting an animal?
CompanionshipAs a GiftHunting DogFor Children/Grandchildren to Play WithGuard Dog

If you want a pet to give as a gift, who are you giving it to?

6. Occupation

Employer

7. Please list the breeds and ages of all pets in your household

8. Do they live
OutsideInside

How many of these animals are spayed or neutered?

Are they current on vaccinations?
YesNo

Are your dogs currently on heartworm preventative?
YesNo

Name and Phone of Your Veterinary Clinic

9. Have you adopted animals from Open Door Sanctuary?
YesNo

If yes, how long ago?

10. Please list all animals you have owned in the last 5 years

Where are these animals now?
Gave AwayLostReturned to AgencyStill HaveDied

Please explain

Have you ever taken an animal to a shelter?
YesNo

Please explain

11. How many hours of the day will the new animal be alone?

Where will the animal be alone at?

12. Where will this animal sleep?

Do you plan on crate training?
YesNo

13. If you are adopting a dog how do you plan to confine this dog when it goes outside?
ChainLeashFenced YardKennelAcreageChain & CableElectric FenceRunner

If your yard is fenced how high is the fence?

14. Have you ever raised a puppy?
YesNo

If yes how long ago?

15. How was your previous dog/puppy trained?
TrainerObedience ClassPersonallyN/A

16. What canine behavior are you UNWILLING to work with?

17. Is this your first experience owning a dog on your own?
YesNo

18. What will happen to this pet if you experience a major life change (such as move, divorce, new baby, or health change)?

19. Do you understand that adopting an animal is a lifetime commitment and are you willing to accept this responsibility?
YesNo

20. Where did you hear about ODAS?

21. Would you like to join the ODAS mailing list to receive event invites and our quarterly newsletter?
YesNo

If yes, what is your preferred contact method?

Because of our concern for placing the appropriate animal in your home, we ask that you read & agree below:
*A representative of the ODAS will visit my home prior to adopting to verify all information given on this application.
*The decision of the ODAS personnel is final.
*All adoptions must meet the criteria of the ODAS general adoption policies.
*I have answered all questions of this application truthfully and to the best of my knowledge.

I agree
YesNo

WE RESERVE THE RIGHT TO REFUSE ANYONE FOR ANY REASON!!!