Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Domino Effect Animal Rescue Adoption Application
Email:
info@dominoeffectanimalrescue.org
Thank you for choosing to adopt! This application is used to assess potential homes for our animals. Please fill out the form honestly. Your home may be perfect for some pets but not be the right match for this specific animal. Please keep in mind that every animal is different. We want to make sure each of our rescues integrate well with their next family so that you and they can live happily together! ❤
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Adopter’s Name
Your answer
Adopter’s Occupation
Your answer
Animal's name you are interested in
Your answer
Address (Street, City, State)
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Facebook or Instagram handle:
Your answer
Who is the animal for?
Your answer
Will you be the primary caregiver?
Yes
No
Clear selection
Where do you live?
House
Mobile Home
Apartment
Condo
Townhome
Clear selection
Does your home have a fenced yard?
Yes
No
Clear selection
If yes, what kind of fence?
Solid Wood Fencing
Chain Link
Wrought Iron
Brick
Vinyl
Other:
Clear selection
How tall is the fence?
Your answer
Do you:
Own your home
Rent your home
Clear selection
If renting, does your lease allow pets?
Yes
No
Clear selection
May we contact your landlord?
Yes
No
Clear selection
If we cannot contact your landlord, please explain why.
Your answer
Landlord’s contact information:
Your answer
May we do a home check?
Yes
No
Clear selection
Where would your pet go if you moved?
Your answer
The animal will live primarily
Inside
Outside
Their choice (I have a doggy/pet door)
Inside only (cats)
Clear selection
Where will the animal sleep?
Outside
In the garage
In a crate
In bed with myself/family member
In bedroom on the floor
Other:
Clear selection
How many hours will the animal be alone (without human supervision) during the day?
Choose
None
1
2
3
4
5
6
7
8
9+
Where will the animal be left when alone?
Your answer
Do you have other pets at home?
Yes
No
Clear selection
If you have other pets, please list breed, sex, age, and if they are spayed or neutered.
Your answer
If you have no other pets at home, have you had pets before?
Yes
No
Clear selection
What are you looking for in your pet/what activities do you plan to do with your animal?
Please check all that apply.
Hiking/Camping
Running/Exercise
Dog Park/Dog Beach
Relax on Couch Together
Cuddle
Playmate for Current Pet
Travel Companion
Therapy or ESA
Service Animal
Office Dog
Working/Ranch Animal
Hunting
Guard/Security
Competitions/Shows (Obedience/Agility/etc.)
Other:
Have you ever trained or gone to obedience classes with a pet?
Your answer
Have you ever had to euthanize a pet? If yes, why?
Your answer
Have you ever had to rehome a pet?
Yes
No
Clear selection
If yes, why did you rehome the pet?
Your answer
Do you have a regular vet? If yes, who/where?
Your answer
What is your budget for routine vet care? Please specify if the amount is monthly, annually, or per visit.
Your answer
What is your budget for emergency vet care?
Your answer
Do you have someone or somewhere that can care for your pet, should you become physically incapable? (Car Accident, Hospitalization, Illness, Injury, or Death)
Your answer
Do you have any children living with you?
Yes
No
Clear selection
If you have children in the house, how old are they?
Your answer
Do all members of the household know about and want this new animal?
Yes
No
Clear selection
If no to the previous question, please explain.
Your answer
Is there anything else you would like to share with us?
Your answer
I certify that, to the best of my knowledge, the information provided in this application is true and complete. I realize that any misrepresentation of that information will result in my losing the privilege to adopt from Domino Effect Animal Rescue. I also understand that this application does not guarantee that I will receive this animal.
Yes
No
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Domino Effect Animal Rescue.
Report Abuse
Forms
