Adoption Application

Rescue and save a life

Ready to Apply?

Please fill out an application. It will only take you about 15 minutes to complete and it is the basic information about you, your family and what you are looking for in a furever friend! We will get back to you as soon as possible once we’ve reviewed your application. If you have any questions, please feel free to email us or message us on Facebook.

Step 1 of 7

Housing Info
Home Address*
Street Address Address Line 2 City State ZIP Code
Are you listed as the owner of the home?*
- Yes
- No
- N/A
How many years have you lived at your current residence?*
Previous Address*
City State ZIP Code
Do you own or rent?*
Landlord Name*
First Last
Landlord Email*
Landlord Phone*
How many residents over 18 reside in the home (including you)?*
How many residents under 18 reside in the home?*
Ages of residents under 18 if applicable
Are there known animal allergies?*

Yard Details
Check all that apply. I have a:*
- Private Backyard
- Private Front Yard
- Private Patio Area
- Private Balcony
- Shared yard space
Check all that apply. I have a:*
- Fenced in Front Yard
- Fenced in Back Yard
- Full Yard is fenced in
- No fence
Please provide details of the fencing type
Type of Fence (e.g. Wood slate privacy fence, Chain link fence, Picket fence)
Height (in ft)
Is fence secure on all sides of yard?
Since your fence is not secure, Please explain

References
We strongly recommend that you give your personal references a head’s up that we might be calling or emailing them. In addition, we recommend that your vet has your permission to release vet information to rescue organizations.
Name of Veterinary Practice
Veterinary Phone
Veterinary Address
Street Address Address Line 2 City State ZIP Code
When was your last visit to this practice, approximately? (Month/year)

Personal References
We strongly recommend that you give your personal references a head’s up that we might be calling or emailing them. In addition, we recommend that your vet has your permission to release vet information to rescue organizations.
#1 – Personal Reference Name*
First Last
(non-family member)
Personal Reference Phone*
Personal Reference Email
Relationship to Reference*
#2 – Personal Reference Name*
First Last
(non-family member)
Personal Reference Phone*
Personal Reference Email
Relationship to Reference*

Information About Pets
Which ASCZ Dog are you interested in?*

If there isn’t one in particular, we can still help you
Do you have dogs in your home currently?*
Please list name, gender, age, breed mix*
Will this be your first dog?*
Please provide any helpful information about past dog ownership prior to current dogs if applicable.
Do you have any specific dog training experience? (Check All That Apply)*
- Housebreaking
- Crate training
- Timid Behavior
- Leash Training
- Leash Reactivity
- Dog to Dog interaction
- Resource Guarding
- Special Needs
- Other
Other training experience?
Do you have cats in your home?*
Please provide age, gender, and personality of your cat(s)*
Do you have other animals (including livestock)?*
Please list your other animals*

Adoption Application

Rescue and save a life

Ready to Apply?

Step 1 of 7

Basic Info

Before you begin…

Housing Info

Yard Details

References

Personal References

Information About Pets

Desirable New Companion Traits

How Can You Help?

we can do it together