DOG ADOPTION APPLICATION
Animal Name:
ID:
851 E. Grand Ave. San Gabriel, CA 91776
T (626) 286-1159 F (626) 286-3165
Hours: Tuesday – Sunday Kennel: 10:00 – 4:30 Office: 8:00 – 5:00
Name __________________________________Email_________________________________Date________________
Address ___________________________________________________________________________________________
Primary Phone _____________________________________ Alternate Phone __________________________________
Thank you for considering the adoption of a rescue! Before you decide to adopt a pet, please consider the time, effort and
funds necessary to properly maintain an animal. Responsible pet ownership requires a commitment to provide care and
companionship for the life of the animal. Please take a few moments to carefully read and complete this application. Please
note there are no wrong answers. This is to ensure that the dog you are interested in is a good fit for you and your home.
Do you currently live in a
Do you currently
Own
House
Apartment
Rent
Condo
Other __________________________________
Lease the residence where you live?
How long have you lived at your current residence? ______________________________________________________
Landlord Name ___________________________Phone Number______________________ OK to contact?
Yes
No
Name(s) of adults that live in your home? _______________________________________________________________
Name(s) and ages of children that live in your home? ______________________________________________________
Does anyone in your household have allergies?
How did you hear about our adoption program?
Yes
No
Friend/Family
Newspaper
Radio
TV
Web
Other
Who will be primarily responsible for the care of this dog? ________________________________________________
Is this dog a gift?
Yes
No If yes, for whom? ____________________________________________________
Which of the following best describes your reasons for wanting this dog? (Check all that apply)
Companion
Guard Dog
For Other Pets For Children
Obedience Training
Search & Rescue
Agility
Jogging
Walking Buddy
Couch Warmer
How many hours will the dog be alone each day? ______________________________________________________
Where will the dog be kept when no one is home? ______________________________________________________
Where will the dog be kept at night? _________________________________________________________________
If you were to move, what would happen to your pet? ___________________________________________________
Can you see this pet as part of your family for the rest of his/her life?
Do you have a fenced yard?
Dog Experience
Yes
No (Dogs can live 14-16 years!)
No If so, how high is your fence ___________Type of Fence______________
First-time guardian
Do you have a regular veterinarian?
Yes
Have had one or two dogs
Yes
No
Knowledgeable & Experienced
Name:_______________________________________________
Which of the following would cause you to give up your dog?
Excessive Barking
Digging
Moving Away
Destructive chewing
Biting/Aggression
Financial problems
New partner doesn’t like dog
Accidents in the house
Would never give up my dog
Please list all of the pets you CURRENTLY have and past pets within the last 5
Species
Breed
Age
Sex
M
M
M
M
M
/
/
/
/
/
Altered
F
F
F
F
F
Y
Y
Y
Y
Y
/
/
/
/
/
Owned how long?
What happened to him or her?
N
N
N
N
N
If you have current dogs: Are their vaccinations current?
Yes
If you have other pets: Are they kept indoor or outdoor?
Indoor
I like dogs that are:
Age:
Sex:
Any Size
Older
No preference
No preference
Small
4-12 months
Female
Large
1-3 years
Male
No
Outdoor
Both
Please describe the temperament and activity level you are looking for in a dog. Check all that apply:
High Energy
Outdoorsy Dog
Lap Dog
Mellow
Affectionate
Quiet
Guard Dog
I prefer a dog that…. (Check all that apply)
Loves children and strangers
Can tolerate children and strangers
Loves all other animals
Can tolerate all other animals
Don’t care if he/she gets along well with other animals
When it comes to relating to dogs, I tend to be more
Strict, demanding (the dog must sit for a cookie)
Moderate, (encourage good behavior, ignoring bad)
Lenient, a little wishy-washy, easily coerced by the dog (the dog looks cute, so he/she gets the cookie even without
performing the sit)
The noise/activity level in my home is usually:
I would enjoy brushing or grooming my dog:
High
Rarely
Medium
Occasionally
Low
Daily
Weekly
Monthly
I would prefer a dog that:
Would enjoy walking with me on leash
Will exercise him/herself in our yard
Would enjoy going to the dog park
Would be outdoors only
Would run, jog, or hike with me
Please describe the ideal dog to fit your lifestyle:
________________________________________________________________________________________________
________________________________________________________________________________________________
I certify that the above information is true and correct to the best of my knowledge. I understand that the completion of this
application does not guarantee adoption. SGVHS reserves the right to refuse adoption to any applicant for any reason.
Signed__________________________________________________________________
Date ___________________
****FOR OFFICE USE ONLY***
Animal ID _________________Reviewed by _________________________________ Date _________________
Approved application Y / N
________________________________
Checked landlord Y / N / NA
________________________________
Other Notes:
_______________________________________________________________________________________________