Pet Central SATX Adoption ApplicationPage 1 of 7InstructionsHi, and thank you for your interest in adopting a rescue dog! The first step in this process is to fill out the following application and submit it. We know it works when you fill it out on a computer. If you fill it out on a phone, we might not receive it, so please email us as well to make sure we hear from you. If you have any problems with the form and/or you haven’t heard from us within 48 hours, please emails us at shaynesrescue@gmail.com for assistance. Please take a moment to gather information before starting because you will not be able to save your information if you have to stop before the application is completed. We will need 2 reference names and numbers, and if you rent you will need your landlord's name and number. If you have had a pet in the last several years, we will want the vets name and number. Please call your vets office so they have authorization to speak to us. We will review your application asap. Please check your emails/texts/vm. It helps us a lot, if you and your references can answer the phone! Let's get started! Dog's NameEnter the name of the dog you are most interested in adopting. If not known put 'Unknown'. You can provide additional details as needed in the next answer.What traits are you looking for in a dog?*Tell us why adopting is important to you and about your experience with dogs*NextAbout YouFull Legal Name (First Middle Last)*Other names usedEmail address*Occupation/Employer*Age*Street Number/Name*City*State*Zip*Home*CellWorkContact Required to progressIf we cannot reach you (by phone, text and/or email) your application will not progress. Check your voice mail and email junk folder. BackNextAbout Your HouseholdIs a spouse or partner living with you?*YESNoYour Spouse/PartnerName*FirstLastEmail address*Home*Occupation/Employer*Cell*Age*WorkAre other adults living with you?*YESNoName*Email*Phone*NameEmailPhoneCommentsPlease tell us about any other people living with you, and about how your expect everyone to respond to a new dog. Are they excited and ready to have a new dog in the house to care for?Are children living with you?*YESNoPlease list all their ages*Are there dogs living with you?*YESNoHow many dogs are living in your household?*1234Name*Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOName*Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOName*Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOName*Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOCommentsCommentsPlease tell us about any other dogs living with you, and about how you expect your dogs to respond to a new dog.Are there other pets living with you?*YESNoHow many other pets (besides dogs) are living with you*1234Name*Type (cat, bird, etc) / Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOName*Type (cat, bird, etc) / Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOName*Type (cat, bird, etc) / Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOName*Type (cat, bird, etc) / Breed*Age*Gender*Please selectMaleFemaleSpayed/Neutered?*Please selectYESNOCommentsCommentsPlease tell us about any other pets living with you, and about how your expect your pets to respond to a new dog.Is anyone in your home allergic to pets?*YESNoPlease describe the severity and what steps you plan to takeBackNextLiving SituationDo you...*Own your homeOwn a condoRent your homeRent an apartment/condoDo you pay a pet deposit?*Please email proof that you can have a dog/puppy at your rental to: gingerdog@live.comLandlord's Name*Landlord's Phone Number*Does your home have a fenced yard?*YesNoHow long have you lived here?*Fence Location*FrontBackBothFence Height*Type of Fence*Chain inkPrivacy (e.g. cedar)OtherPlease describe fenceDescribe conditions (acreage, near a lake or parks; someone always home; etc)*Are there any breed specific regulations in place where you live?*YESNOI DON"T KNOWWhat are they?Have you ever had to surrender or re-home a dog?*YESNOWhat were the circumstances?*BackNextAccomodationsHow long will the dog be left alone?*0 - 2 hours2 - 4 hours4 - 8 hoursOver 8 hoursIf the dog will be alone for more than 4 hours a day do you plan on using dog walker or day care services?*Where will the dog stay in the day?*InsideOutsideBothWhat do you have for the dogs comfort when staying outside?Where will the dog stay at night?*InsideOutsideBothWhere will the dog sleep inside?*Someones bedStand alone dog bedCrateSeparate roomWho will be responsible for exercising the dog?*Please check which traits are important to youKid friendlyDog friendlyTolerant of catsMaleFemaleSubmissive to other dogsWhat types of training do you feel comfortable withHousebreakingBasic obedienceSocialization - dogsSocialization - kidsSocialization - catsResource guardingMouthing/nippingWhich size dogs can you work with?Small < 25 lbsMedium 25 - 50 lbsLarge 50 - 75 ;bsExtra large > 75 lbsAnything else we should know about finding the right match for you?BackNextReferencesAre your pets medications/vaccinations current?YESNOSOMEIf you have now or have had a pet in the past 10 years, please provide a vet reference. Please call their office to authorize us to speak to them. If you have not, please put N/A on each item.Vet's Name*Location*Phone Number*You must enter two references for your application to be accepted. Name*PERSONAL REFERENCE 1Relationship*Phone Number*Name*One reference must not be a family memberPERSONAL REFERENCE 2Relationship*Phone Number*In a worst-case scenario, who would happily take your dog temporarily/permanently if needed? You can list more than 1 Back-Up Person. Please give us their Name, Relationship, Address, Phone #, and Email.*Please provide their names, phone numbers, email addresses and relationship to that person(s).BackNextAdoption AgreementPlease select 'YES' next to each item to indicate your agreementI / we agree to take this dog to the vet within 30 days of adoption for a check up.DO YOU AGREE?*YESNOI / we understand that this is a rescued animal and although we do our best to determine the temperament and current health status of the animal there is no guarantee on health or temperament.DO YOU AGREE?*YESNOI / we agree that if we are ever have to give up this dog for its ENTIRE lifetime, it can ONLY come back to Pet Central SATX Rescue, no matter length of time. I/we agree to foster the dog until a home can be found. If we cannot foster and there is no other foster available, Pet Central SATX Rescue will board the dog until adopted, and boarding fees will be deducted from the adoption fee refund, if during the trial period.DO YOU AGREE?*YESNOI / we authorize Shayne's Rescue and Pet Central SATX to perform a background check.DO YOU AGREE?*YESNOI/We agree to keep in touch a minimum once/month for the first 18 months . I/We will also contact you asap for the dogs entire life if there are any behavorial and/or medical issues.DO YOU AGREE?*YESNOI / we agree to complete age appropriate immunizations for this dog as needed and to maintain appropriate immunizations for its entire life.DO YOU AGREE?*YESNOI / we agree that if the dog needs to be re-homed or we can no longer keep it for any reason, we will return the dog to the adoption liaison point of contact Ellen Dorfman (text 360-480-9531 and email shaynesrescue@gmail.com), AND notify Terry Wheeler (text 210-394-6060 and email petcentralsatx@gmail.com). We will not take the dog to a shelter, rescue, or re-home the dog without WRITTEN advance approval.DO YOU AGREE?*YESNOYou are agreeing to these terms by printing your name and date below.*BackSendThis field should be left blank
