Adoption Application


Fill out the form below, or print out a PDF application.

Name of Pet You are Interested In (required)

Your Full Name (required)

Street Address (required)

City, State, Zip Code (required)

Home Phone (required)

Cell Phone (required)

Your Email (required)

Your Occupation (required)

Your Employer (required)

Name of Spouse / Partner (if applicable)

List members in household by gender and age, one per line (required)

Have you ever owned pets before?

List pets you currently own by species / gender / spayed / neutered (required):

Is anyone in your home allergic to dogs or cats?

Are you willing to pay to transport your pet to you (if necessary)?
 Yes No Maybe

Do you own or rent your home?
 Own Rent Live with Parents

Can you provide proof that your landlord or HOA allows pets?

How long have you lived at your current address?

Where will you keep your pet during the daytime?

Where will your pet sleep at night?

How will you care for your pet during overnight family absences and vacations?

What type/brand of dog food do you plan to feed your dog?

Do you have a fenced yard?

How will you ensure your pet's safety?

Where will your dog spend his/her time when alone?

Do you plan to use a crate?
 Definitely Maybe Probably Not

What will you do if your dog is destructive when left alone?

Are you willing to attend obedience training with your dog?
 Yes Maybe No

Have you ever surrendered, sold, or given away your pet to an animal shelter or rescue group?

If yes, why?

Has anyone in your immediate family or household ever been convicted of a charge related to cruelty to animals or child abuse?

Are there any charges pending now?
 Yes. No.

Who is or will be your regular veterinarian? (Include address and phone number)

Please provide Three References...including phone number and email (required)

Are you willing to email us a photo of your home, yard, and fence prior to adoption?
 Yes. No.

Do you have any more information you would like Upward Dog Rescue to consider in reviewing your application?

How did you hear about us?

By checking the box below, I agree that I have answered the questions to the best of my knowledge and have not knowingly submitted false or misleading replies. I understand that Upward Dog Rescue reserves the right to refuse adoption to any applicant.
I accept these terms.

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