Kismutt Small Dog Rescue

Adoption Application

Your responses to the questions listed below are confidential. The purpose of this questionnaire is to ensure that animals are placed in appropriate homes, which are capable of giving a new pet the highest quality of care and a lifetime commitment.

The application gives us an idea about who you are and what the circumstances the adopted dog will perhaps live in soon. If you feel the questions and the answers you are filling in are not representing you adequately, please feel free to add additional information. For us, these questions are not everything. They try to make sure you are aware of what you are doing and what kind of responsibility you are getting yourself into. It's not one or the other question or answer that will make the difference, but it's the whole picture. So don't get discouraged!!

Date:

Name:

Address:

City:

Postal Code:

Home Number:

Cell Phone:

Work Number:

Email:

Please explain your reasons for wishing to adopt a dog.

Is everyone in the household in agreement to adopt a dog?

Have you discussed adopting a dog with everyone in the household before completing this application?

For whom are you adopting a dog? For you or for someone else? (If for someone else, who?)

Are you 21 years of age or over?

Do you live in a house, apartment, condominium or townhouse?

Do you own or rent?

If you rent, does the landlord permit the type and number of pets you wish to have?

Please list number of adults and number of children living in the home.

How long have you lived at your current address?

Have you ever been investigated by the OSPCA or SPCA?

Do you have children? If so, please list their ages.

Is any member of your family allergic to dogs?

Do you currently have any pets?

If so, what pets do you have? What are their ages? What are their temperaments?

Are they all spayed or neutered?

Have you had pets in the past? What happened to them?

Do you have a fully fenced in yard?

Who is your veterinarian? Please provide vet's name and number for reference.

Name:

Address:

Postal Code:

Telephone Number:

(Please phone your vet's office a.s.a.p. and let them know we will be calling them for a reference. Your vet needs your permission to release a reference, due to the privacy act.)

What canine behavior would you find totally unacceptable and why?

Are you willing to seek guidance should you experience behavioral challenges?

Are you willing to work with a dog that is not fully housebroken?

If you are applying to adopt a puppy or dog that is not housebroken, how do you plan to housetrain your new puppy/dog?

What is your work schedule like? How many hours per day will the dog be home alone?

In what type of lifestyle do you want your dog to live? Inside, outside, both?

Where will the dog be kept primarily? (house, yard, garage, other)

Check any of the following reasons you would give your dog away:

Fleas ............................ Getting married or divorced
Allergies ..................... Chews or destroys objects
Too expensive ............. Children no longer care for it
Having a baby ............. Moving where no pets allowed

Sheds too much Other (please specify)_________________

Is there a specific dog that you would like to adopt? If yes, why do you wish to adopt this dog?

What qualities are you looking for in a dog?

Would you have any objection to someone from Kismutt Rescue coming to your home to conduct a home check prior to the adoption of a dog?

Do you agree that if you adopt this dog and for any reason cannot keep the dog, that you will return it to Kismutt Rescue?

How did you hear about Kismutt Rescue?

Please list two references with phone numbers, not including your vet, and advise them we will be calling in the next few days. Thank you.

Reference One

Name:

Relationship to you:

Telephone number:

Reference Two

Name:

Relationship to you:

Telephone number:

I, the undersigned, have read, understand and completed the adoption application. I further declare that all of the information supplied on this application form is true and accurate. I understand that false information may result in nullifying this adoption. Kismutt Small Dog Rescue reserves the right to refuse adoption to anyone for any reason. I understand that no animal can be held for me. If this application is approved I am prepared to meet with the dog within 3 days of being notified that I have been approved.

Kismutt Small Dog Rescue does not and cannot guarantee animal health and/or temperament. Any known medical conditions or treatment has been explained to you prior to signing this application. While every reasonable effort is made to ensure animal health, temperament and adoptability, Kismutt Small Dog Rescue is not allowed to assume responsibility for animal health or temperament after adoption.

***The College of Veterinarians of Ontario (CVO) O. Reg. 1093 (Sec. 38) stipulate that once an agreement to adopt an animal has been made and the possession of the animal has changed, the responsibility for acquiring a veterinarian immediately falls to the person adopting the animal. The owner is 100% responsible for any decisions regarding choice of veterinarian and treatment. Section 38 of the Regulation ensures that a member of the public is free to utilize a veterinarian of their choice and is not directed or “steered” to a particular one***

Signed: _________________________________ Date: _____________________

(If sending by email your name typed here will be an e-signature)

Please submit the application by email to kismutt@sympatico.ca

Thank you from all of us at Kismutt Rescue.