Canine Pre-Adoption Application



Please fill out this form completely, then PRINT and MAIL to the address at the bottom of this form.

Adopting a dog brings with it a lot of responsibility, including annual veterinarian visits, vaccinations, and possible emergency care. This is more expensive than many people realize. Are you aware of and prepared to assume responsibilities for your newly adopted dog? Yes No

Adopter's Information

Name: Phone#: Email:

Address-City-State-Zip:

Background Information

Currently own or rent: Own Rent

How long have you owned?

How long have you been renting?

If renting please supply us with you landlord's name and phone number.

Landlord's Name: Phone Number:

Are you a first time dog adopter as an adult? Yes No

Please list Veterinarian references: Name & Phone Number:

Please list the cats and dogs that you currently live with or have lived with in your adult life:
Type/Breed:
Pet's Name:
Spayed/Neutered:
Do you still own them?
How many adults in your home? How many children in your home? Ages of children? Does anyone in your family suffer from allergies? Yes No

Your new dog: Physical Traits

Gender of dog you're looking for? Male Female Doesn't Matter

What type of breed?     No Preference

What age range are you looking for? Puppy Adult Senior Doesn't Matter

Preferred coat length: Short Medium Long Doesn't Matter

Size of dog you're looking for?

Toy (0-10lbs) Small (10-25lbs) Medium (25-50lbs) Large (50-100lbs) Doesn't Matter

Your new dog: Other Traits

What role would you like to see your new canine companion play in your life?



List some traits that you would like most in your new dog:



List some behaviors you would have a hard time dealing with in your new dog:



If your new dog displays behavioral problems - such as jumping on people, inappropriate chewing, housetraining problems, etc. - how would you go about teaching him/her:


Home Life

How would you classify your home? Calm Some Activity Extremely Busy

How many hours a day will your dog be left alone and where will your dog be kept when unsupervised?



Where will your dog sleep at night?



Do you have a fenced in yard?

Yes No

If yes please describe it.    If no, how do you intend to keep your dog on your property?



Who will be responsible for your dog's exercise and how will this be done and how often?



In the shelter environment, it is difficult for us to determine if a dog is housetrained.

Would you be able to tolerate a few accidents? Yes No

What kind of solution would you be willing to try if housebreaking accidents continue after the first week?



In submitting this Pre-Application form you are giving Second Chance Animal Center permission to verify your housing status and Vet references.

Please PRINT and MAIL this Pre-Application Form to:

Second Chance Animal Center
P.O. Box 620,
Shaftsbury VT 05262
Attn: Canine Pre-Application