Dog Adoption Application

Copy the following application and paste it into an email to fill it out.

Dire Straits Companion Animal Rescue


Name of pet you are applying for:


Applicant/Co-Applicant Information

Last Name: First Name: DOB:

Last Name: First Name: DOB:


Apt #

City, State and zip:

Home Phone:

Cell Phone:

Email Address:

Do you own?

Rent? Landlord’s Name: Phone:

How long have you lived at this address?

Any plans to move in the near future?

How did you hear about Dire Straits?

Family/Household Information

Number of adults in the household:


Have all the adults in the household agreed to this adoption?

Number of children in the household and their ages:

Have the children had pets before?

Do you expect your current family situation to change?

Is anyone in the household allergic to pets, if yes, who?

What are your reasons for adopting a pet? (Check all that apply)

____ Companion for self ____ Companion for other household member ____ Gift ____ Watchdog
____ Companion for child ____ Companion for other pet ____ Other (explain)

Employment Information

Employer and position held:


Work phone:

How long have you been with this employer?

Pet Information

Please list current pets:






Have you ever given an animal away or relinquished an animal to a shelter?

If yes, what were the circumstances?

Has a pet ever gotten lost?

Has a pet been hit by a car?

Have you had a pet euthanized?

Explain any “yes” answers:

Are your current pets up to date on vaccines and on monthly heartworm preventative?

Veterinarian/Clinic Name:


New Pet Information

How much time are you prepared to allow for your new dog to adjust to your home?

How much do you expect to spend on maintenance for your dog in a year?

Are you able to afford a bill of $300-$900 (or more) for emergency veterinary care?

Are you committed to providing a responsible, loving home for your dog’s entire life (15+ years)?

If you have to move, what do you plan to do with your pet(s)?

Who in the household will be the dog’s primary caregiver?

When you are out of town, who will be the dog’s primary caregiver?

In case of emergency, who will care for your dog?

How many hours per day will your dog be left alone?

Where will the dog be kept during the day?

At night?

How do you plan to house-train your dog?

Will you attend dog obedience classes?

How will you reprimand your dog for chewing, digging, house-training mistakes or mischievous behavior?

What type of food and how often will you feed your new dog?

How often and where will you exercise your dog?

Do you have a COMPLETELY fenced yard?

If yes, what type/size?

What would you do if your dog develops a problem with:




Separation Anxiety:


References – Please list 3 personal references who are not related to you.

1 (Name) (Relationship) (Phone Number)

2 (Name) (Relationship) (Phone Number)

3 (Name) (Relationship) (Phone Number)

By signing below, I certify that the information I have given is true. I understand that Dire Straits Companion Animal Rescue reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application.





Please email application to: