RAWL Adoption Form

Name of Dog:

Date:

Our goal is to make a compatible match between a dog and its potential owner. We do not guarantee your application will be approved for the dog your are interested in adopting. The adoption fee is $200.00.

I am 23 years of age or older.

SECTION ONE - Contact Information

First name

Last name

Email

Cell Phone

Home Phone

Work Phone

Address

SECTION TWO - Housing Information

Which best describes your housing:

Do you rent or own:

Rent

Own

If you rent, please provide your landlord name and phone number:

How long have you lived at the present address:

Number of adults in the household:

Number of kids in household:

Ages of children

Are all the adults in the household aware that you are adopting a dog?

Yes

No

Who will be the primary caregiver for your new dog:

Does any member of your household have an allergy to dog hair/dander?

Yes

No

Explain your decision for adopting a dog:

SECTION THREE - Pet Information

Name and phone number of current/past vet:

City and State:

Do you authorize your current/past vet to speak with a RAWL representative?

Yes

No

Please list the following background information on current/former companion pets - See info needed below:

1. Name

2. Type of Animal/Breed

3. Age

4. Sex

5. Spayed/Neutered

6. Vaccines Current

7. On Heartworm Preventative

8. Years Owned

9. What happened to the pet

Are current pets compatible with other animals?

Yes

No

If "No", please explain:

SECTION FOUR - General Information

Do you have a yard? If yes, what is the size? Is it fenced in? What is the height/type of fence? Is there a gate?

Do you have a doghouse, outside pen, or kennel? If so please describe.

Are there times when the dog will be tied outside?

Yes

No

If yes, explain:

Is someone going to be home during the day?

Yes

No

How long will the dog be left alone?

Where will the dog be kept when left home alone? (i.e. crate, free roam)

Where will the dog be kept during the day when you are home?

Where will the dog sleep at night?

When you go on vacation or travel who will care for the dog?

If the dog is not house-trained, what method will you use to train it?

Explain how you will discipline the dog:

Do you plan to attend obedience classes for your new dog?

Yes

No

How much do you expect to annually spend on medical bills for your dog?

Pet ownership is a lifetime commitment, what provisions would you make/take if you:

Move:

Divorce:

Become incapacitated:

Have you filled out a RAWL adoption application before? If yes, please list when.

Are you aware that RAWL reserves the right to conduct home visits?

Yes

No

I certify that the information above is true and understand that false information will result in nullification of this application.

Signature

Adoption Form

RAWL Adoption Form

Reminder: RAWL is a non-profit IRS 501(c)(3) organization.

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Registered Charity Number : 54-1568203