Pinealope Animal Rescue 

Where every life counts

Adoption Application

We spend a lot of time reviewing applications so please be thorough when filling in the blanks.  Applications half answered will not be responded to.

Name of dog applying for
Phone Number/s
COMPLETE Physical Address
Name, number of current veterinarian
Where did you hear about us
Are you a first time Dog owner
Do you have experience with this breed of dog? IF YES EXPLAIN
Where will the new dog be allowed in the home? (run of house, kitchen, living room, etc.)
Do you Rent or Own and how long have you lived at this address
Type of Housing? (house, duplex, mobile, apartment, etc.)
If renting provide, Company name & number of Landlord
How will you confine this dog while outside? (fence (include height), leash, kennel, etc.)
List names/ages of all Adults in the home (18 & older)
List each current dog including their ages
How many dogs and cats have you had in the past 7 years
Are current pets UTD on shots, spayed/neutered & on prevention? If no Explain
What brand / type of food will this dog eat
Do you have any experience with house/crate training, Chewing, Biting, Sep. anxiety? If yes explain
Your employer info: Including name, number and your position
Your spouse's employer, including name, number and your position
Electronic Signature of Applicant
Name of person applying
List 3 references including their contact number (co-worker, neighbor, friend, previous org. adopted from)
Length of time with current vet
List the number of children in the home and their ages (17 & younger)
How many dogs and cats do you have now
List each current cat including their ages