Adoption Preferences
Which dog are you interested in adopting
How did you become aware of this dog?
Our website
Petfinder
Adopt-A-Pet
Facebook
Instagram
Friend/Family referral
Other
If other, please specify:
Why do you want to adopt this particular dog
What special needs have you been told will be needed by this dog after adoption (if any)?
I am adopting
Family pet
Child's companion
Gift
Companion for self
Hunting dog
Breeding
Guard dog
Protection
Companion for my pet
Applicant Information
First & last name
Date of birth
Address
City
State
Zipcode
Length of time at address
Driver's license number?
Email
Preferred phone number
Occupation
Hours at work each week
Employer's name
Years employed there
Employer address & telephone number
Please list 2 references you have known for at least 5 years who are not members of your immediate family. Include name, phone number, relationship and how long you have known them.
Do you have any health conditions which could restrict your ability to care for a dog
Have you owned dogs or currently own dogs
Yes
No
In the past, have you applied to adopt from another rescue group or shelter
Yes
No
Name of organization/shelter:
Did you adopt?
Yes
No
If no, why not?
Spouse or Partner's Information
Do you have a spouse or partner?
Yes
No
Spouse's/partner's name
Spouse's/partner's date of birth
Spouse/partner's driver's license number
Spouse's/partner's email address?
Spouse's/partner's preferred phone
Spouse's/partners occupation
Hours at work each week
Spouse's/partner's employer
Years employed there
Spouse's/partner's employer address & telephone number
Home Environment
Individiuals who share your home (names, ages & relationship)
Are there regular visitors to your home (human or animal) which your new dog must get along with
Yes
No
List any minors who live with you and their ages
Living arrangements
House
Apartment
Condo
Mobile home
Do you own the home
Own
Rent
Can you provide proof of ownership
Yes
No
Length of time renting
Landlord name
Landlord phone number
Do you have written permission to have the dog you want to adopt?
Yes
No
What are your plans for your dog if you move locally:
Out of state
Out of the country
If you choose to move to a place where pets are not allowed, what would happen to the dog?
Do you have a doggie door
Yes
No
Where is the doggie door
When is the doggie door left open
Do all doors that exit your home have screen doors?
Yes
No
Please list the ones that do not.
Do you have a backyard or patio?
Backyard
Patio
Neither
Is your backyard completely fenced
Yes
No
Fence type:
Block
Chain link
Wooden
Rod iron
Lowest height of fence
Do you have a gate?
Yes
No
Lowest height of gate
How is the gate secured
Latch
Keyed lock
Deadbolt
Padlock
I do not lock the gate because:
Is your yard space shared with other tenants
Yes
No
Do you have a pool, Jacuzzi or spa
Yes
No
Is the pool, Jacuzzi or spa fenced seperately from the rest of the yard
Yes
No
What is the lowest height of the fence around the pool/spa/jacuzzi in feet
Do you have a pool cleaner, gardener or housekeeper?
Yes
No
Where will the dog be kept while they are working
Is someone home during the day?
Yes
No
No. of hours dog will be alone on weekdays
On weekends
Where will you keep the dog when you are not home
How will the dog "potty" when you are not home
Is anyone in your household allergic to dogs
Yes
No
Which of the following would you choose for flea control
Flea spray
Flea bath
Herbal flea control
Flea collar
Advantage/Frontline
Flea comb
Prescription program
Other
Identification methods you use on your pets
Collar with tag
Microchip
Other
What type of food will you feed your dog
Wet
Dry
Raw
Describe your feeding schedule
What provisions/plans have you made for your pets in the event you become disabled or die
Number of hours your dogs spend/spent indoors?
Where will your dog spend the day
In the house
In the yard with dog house
In and out of house with dog door
Dog kennel run
Garage
Patio
Deck
Other
If other, please explain:
Where will your dog spend the night
In the house
In the yard with dog house
In and out of the house with door door
Dog kennel run
Garage
Patio
Deck
Other
If other, please explain:
Where will your dog go when you are on vacation
With family
With pet sitter
At boarding kennel
At vet office
In the garage
With a friend
Neighbor will feed
Other
If other, please explain:
How will your dog get exercise
In which of the following situations would you expect your dog to be off leash
Public park
Neighborhood walk
Work site
Dog park
Front yard
Hike
Beach
Backyard
Other
If other, please explain:
What dog behavior would not be acceptable to you
Explain behavioral concerns
Which of the following would force you to give up your dog
Out-of-state move
Plans to have a baby
Longer work hours, schedule change
Divorce/separation
Return to school/college
Marrying/dating someone with dog allergies
Dog develops chronic illness
Large veterinary expenses
Loss of dog bladder or bowel control
Dog barks too much and neighbors complain
Dog nips at strangers
Dog is untrainable
Dog exhibits separation anxiety
Dog is destructive when not supervised
Dog is not the kind I thought it would be
Dog grew larger than anticipated
New dog and current pets are not compatible
None of the above
Other
Please explain:
Have you taken a dog to obedience class
Yes
No
If yes, where?
Would you be willing to take this dog to obedience classes
Yes
No
What method do you intend to use to housetrain your dog
Veterinary
Vet's name
Vet's telephone number
Do we have your permission to call your veterinarian for records?
Yes
No
Are you prepared to cover any vet expenses your dog may incur throughout its lifetime
Yes
No
What is a reasonable amount to spend if your dog becomes very ill
How much is too much
What is your general veterinary ability
Within budget constraints
Will purchase pet insurance
Spare no expense
If a great expense, I would return the dog
Would you consider euthanizing your pet because of any of the following (check all that apply)
Medical costs
Health suffering
Old age beyond life expectancy
Behavioral concerns
Current & Past Pets
How many current pets do you have?
0
1
2
3 or more
How do you feel your current pets will adjust to the new dog
Are your pets socialized with dogs?
Current Pet Name #1
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Current Pet Name #2
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Current Pet Name #3
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Past / Previous Pets
Have any of your pets died from parvovirus, distemper, feline leukemia or any other contagious disease
Yes
No
How many past pets have you had?
0
1
2
3 or more
Past Pet Name #1
Breed
How obtained
What years did you own the pet?
Specifically, what happened to the pet?
Pet's vet
Vet's telephone number:
Past Pet Name #2
Breed
How obtained
What years did you own the pet
Specifically, what happened to the pet
Pet's vet
Vet's telephone number
Past Pet Name #3
Breed
How obtained
What years did you own the pet
Specifically, what happened to the pet
Pet's vet
Vet's telephone number
Please read the following statements and check all. By doing so you agree to each commitment.
I agree to a home visit prior to adoption. I understand that a member of the AALOC Kennel Committee will contact me within one week to set up a home visit if my application is approved, and neither the application nor home visit guarantees that the adoption will be approved.
I agree to a home visit prior to adoption. I understand that a member of the AALOC Kennel Committee will contact me within one week to set up a home visit if my application is approved, and neither the application nor home visit guarantees that the adoption will be approved.
I understand that a veterinary reference is required in order to adopt a pet from AALOC if you currently or previously owned a pet. If the veterinarian does not have records for my past/current pets, the application will be denied.
I understand that a veterinary reference is required in order to adopt a pet from AALOC if you currently or previously owned a pet. If the veterinarian does not have records for my past/current pets, the application will be denied.
Submitting this form constitutes your permission for us to check references. I am in full agreement with these terms of adoption. I agree that no member of my family/household has ever been charged with cruelty to animals or children, dog fighting or other crimes relating to animals.
Submitting this form constitutes your permission for us to check references. I am in full agreement with these terms of adoption. I agree that no member of my family/household has ever been charged with cruelty to animals or children, dog fighting or other crimes relating to animals.
I agree that I will provide the pet with adequate food, water, shelter, training, affection, and medical care.
I agree that I will provide the pet with adequate food, water, shelter, training, affection, and medical care.
I understand that Animal Assistance League of Orange County is not responsible for the accuracy of information received about the habits, temperament, or physical condition of pets available for adoption. I understand that it is my responsibility to evaluate the pet for myself before agreeing to adopt it.
I understand that Animal Assistance League of Orange County is not responsible for the accuracy of information received about the habits, temperament, or physical condition of pets available for adoption. I understand that it is my responsibility to evaluate the pet for myself before agreeing to adopt it.
I understand and agree that I must and will return the dog to AALOC if I am no longer able to care for it. I understand that I may not take it to another animal shelter, humane society, other owner, research facility, or other organization.
I understand and agree that I must and will return the dog to AALOC if I am no longer able to care for it. I understand that I may not take it to another animal shelter, humane society, other owner, research facility, or other organization.
I agree that all the information I have provided in the above application is true and honest. I understand and agree that if AALOC discovers an omission or information contained in this application to be false, AALOC reserves the right to annul the adoption and reclaim the animal from my premises without refund or money paid.
I agree that all the information I have provided in the above application is true and honest. I understand and agree that if AALOC discovers an omission or information contained in this application to be false, AALOC reserves the right to annul the adoption and reclaim the animal from my premises without refund or money paid.
I agree that AALOC shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, cause of action, fines, suits, demands, judgments or claims of any nature whatsoever arising from or by reason of any damage to property or injury to any persons caused in whole or in part by the dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold AALOC harmless from and against all the aforesaid.
I agree that AALOC shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, cause of action, fines, suits, demands, judgments or claims of any nature whatsoever arising from or by reason of any damage to property or injury to any persons caused in whole or in part by the dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold AALOC harmless from and against all the aforesaid.
I understand that an adoption donation is required. All dogs and cats are spayed or neutered prior to adoption, vaccinated, dewormed, microchipped, and ID tagged. All cats are tested for Felv, FIV and ringworm.
I understand that an adoption donation is required. All dogs and cats are spayed or neutered prior to adoption, vaccinated, dewormed, microchipped, and ID tagged. All cats are tested for Felv, FIV and ringworm.
Applicant signature
Date
Witness signature
Date
Submit