Dog Adoption Application | Plainfield, IL

Dog Adoption Application Form

What dog(s) are you are interested in (please write at least one name or we cannot review) :*

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Today's Date*

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What is your timeframe for adopting a dog?*

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Primary Adopter Information

Full Name:*

Please type your full name.

E-mail:*

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Cell Phone Number:*

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Birthday - month and year only *

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Street Address:*

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City:*

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Please note we only adopt to homes in Chicago and in the surrounding suburbs. Please do not complete this application if you live out of our adoption radius - the response will be that you are out of the adoption radius.

State:*

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Please note we only adopt to homes in Chicago and in the surrounding suburbs (mostly IL, some WI and IN areas) Please do not complete this application if you live out of our adoption radius - the response will be that you are out of the adoption radius.

Zip Code:*

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Employment Information

Employer:*

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Current Position:*

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Secondary Adopter Information

Full Name:

Please type your full name.

Relationship to Primary Adopter:

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Birthday: Month and Year only

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E-mail:

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Cell Phone Number:

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Street Address:

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City:

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State:

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Zip Code:

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Secondary Adopter Employment Information

Employer:

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Current Position:

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Residence Information

Number of years at residence:*

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If less than 1 year, what was your prior address?

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Type of Property:*

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If "Other", please indicate type of property:

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Do you Own or Rent your home?*

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If you rent- Landlord/Complex Name:

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If you rent- Landlord/Complex Phone Number:

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If you rent- Are you allowed pets?

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If you rent: Are there any pet restrictions? Please describe:

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Do you plan to move within a year and if so, where?*

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Family Information

Number of adults in household:*

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Ages and Relationships of Adults in Household:*

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Number of children in household:*

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Ages and Relationships of Children in Household:*

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List the age and relationship of anyone else who may be a frequent guest in your home (ie, grandkids who regularly visit, kids you babysit, a partner or relative who stays often but doesn’t live there). *

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Is anyone in your household allergic to animals?*

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If yes, who and to what type of animal. Otherwise, type NONE:

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Pet Caregiving

If you have to move in the future, what will you do with your pets?*

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Who in the household will be the pet's primary caregiver?*

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What are your beliefs regarding spaying/neutering?*

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Have you ever turned an animal in to a shelter?*

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If you have returned a pet to a shelter, please explain:

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Who is or will be your Veterinarian? *Please complete for all animals owned in the past 5 years even if deceased.**

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Veterinarian's City:*

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Veterinarian's Phone Number:*

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Are all you're pets up to date on vaccinations? We will be requesting records to verify a history of vaccination and heartworm prevention.*

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Are all dogs and cats in your home spayed or neutered? Animals in your home MUST BE ALTERED before adoption*

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Training Information

How will you introduce your new pet to other animals in the household. If no other pets, type NONE:*

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How much time are you prepared to allow for your new pet to adjust to your home and other animals? If no other pets, type None:*

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What is the best way to correct your pet’s mistakes?*

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If you are applying to adopt a puppy under 6 months old, please include any puppy management plan you have to care for them since young puppy needs vary from an adult. (include N/A if applying for an older dog)*

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Will you be enrolling your dog/puppy in obedience class?*

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If yes, where will you enroll them?

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If you won't be enrolling your dog/puppy in obedience, why not?

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Have you previously trained a dog/puppy?*

YesNo Invalid Input

If yes, what is the name of the facility/trainer you used? Have you used a prong or e-collar as part of training?

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Are you familiar with crate training?*

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Are you familiar with house training?*

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What training methods do you plan to use with your new dog/puppy? Please describe what "Positive Reinforcement" means to you. *

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What types of socialization opportunities will your dog/puppy have?*

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Agreement

By entering my FULL NAME and DATE below, I certify that the information provided is complete and correct. I realize that any misrepresentation of fact may result in my losing the privilege of adopting an animal. I understand that Starfish Animal Rescue has the right to deny my request for adoption. I authorize verification of all statements on this application including but not limited to prior vet medical history. I understand that this application is the property of Starfish Animal Rescue who reserves the right to share this information with other shelters and rescue organizations.*

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Digital Signature. Use Mouse or Touchscreen to sign below.*

Sign Above

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Are you a Robot?*

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Dog Adoption Application Form

Primary Adopter Information

Employment Information

Secondary Adopter Information

Secondary Adopter Employment Information

Residence Information

Family Information

Pet Caregiving

Lifestyle Information

Training Information

Pet Characteristic Information

Owner Responsibility

Agreement