Size
(when grown) Med. 26-60 lbs (12-27 kg)
Details
Good with kids,
Good with dogs,
Good with cats,
House-trained,
Spayed or Neutered,
Shots are up-to-date,
Story
*We are not currently accepting phone calls. If interested in adopting please email*
Daisy is about 1.5 yrs old. She was adopted through us when she was about 4 months old. She is a very sweet girl but was returned to us. She is current on all vaccines, heart worm tested and is negative, and spayed. She did loose a little weigh when she was returned to us but she is doing well in her foster home. Daisy needs additional training. She is an active girl and would do best in an active home. She is crate trained and house trained. She listens well to basic commands but does still have puppy energy. She will jump up people. She is a resource guarder. She does get along with other animals but can be very protective of her things. We would like to place her in a home with no other animals and no young kids. If interested in adopting her please email changingheartsrescue@aol.com.
Application:
Dog Adoption Application Form
Contact Information
Full name:
Occupation: ______________________________________________________________
Address: ______________________________________________________________
How long at this address:__________________________________________________
Daytime Phone: ___________________________________________________________
Evening Phone: __________________________________________________________
Best time to call: ___________________________________________________________
Email address: __________________________________________________________
Family & Housing
How many adults are there in your family (their relationship to you)?
_________________________________________________________________________
How many children (ages)?
_________________________________________________________________________
What type of home do you live in single family, town home, apartment, farm, etc.?
_________________________________________________________________________
Please describe your household: __ Active __ Noisy __ Quiet __ Average
If you rent, please give the rules governing pets and the landlord's name and number:
(by providing this information you are allowing CHR permission to contact your landlord please inform them of this call so they will speak with us)
Does anyone in the family have a known allergy to dogs? _________________________
Is everyone in agreement with the decision to adopt a dog? _________________________
Do you have time to provide adequate love and attention? _________________________
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines? _________________________________________
Are these pets spayed/neutered? If not. Why?____________________________________
_________________________________________________________________________
Have you every surrendered a pet? If so, why?
_________________________________________________________________________
Have you ever had a pet euthanized? If so, why?
_________________________________________________________________________
Have you ever lost a pet to an accident?
_________________________________________________________________________
How do you discipline your pets and why?
_________________________________________________________________________
Veterinarian
Do you have a regular veterinarian? __ Yes __ No
Veterinarian's name: _______________________________________________________
Clinic Name: _______________________________________________________
Clinic Address: ________________________________________________________
Clinic Phone: ________________________________________________________
(Providing CHR with this information you are allowing CHR to call your vet. Please call your vet and ask them to authorize the release of information to CHR.)
About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?
Desired age: __________ Desired Size: _____________________________________
Desired breed: _______________________________________________________________
Breed you would not adopt:_____________________________________________________
Desired sex: _ Spayed Female _ Neutered Male _ No preference
Willing to adopt: __ outgoing/hyper dog __ shy dog
__ dog that needs regular medication __ dog that needs training
__ dog that needs grooming __ None of these
Where will the dog spend the day? (describe)
_________________________________________________________________________
Where will the dog spend the night? (describe)
_________________________________________________________________________
Number of hours (average) dog will spend alone? _________________________________
Who will have primary responsibility for this dog's daily care? _______________________
Who will have financial responsibility for this dog? ________________________________
Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No
Do you agree to keep the dog as an indoor dog? __Yes __No
When the dog goes out, how do you plan to supervise it? Fenced yard?
Do you agree to contact CHR if you can no longer keep this dog? __Yes __No
Are you be willing to let a representative of CHR visit your home by appointment?
__Yes __No
How did you hear about CHR? _____________________________________________________
Would you be interested in fostering? __Yes __No __Would like to know more
Personal References
Please list someone who is familiar with both you and your pets.
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
___________________________ _________
(Signature) (Date)
