Underdog Rescue of Florida


Please enter as much information as possible.  Fields marked with required.  If you are having problems with this application, please contact us by using the contact information at  the bottom of this page.  If you prefer to fax, please click here to download an application in PDF form.  If you need Adobe's free reader click here.
Name of dog interested in:
Name:
Address:
City: State: Zip:
Phone: Other Phone:
Email Address: Your Age:

Please list the names, ages, and relationships of all other persons residing in your household:

Name: Age: Relationship:
Name: Age: Relationship:
Name: Age: Relationship:
Name: Age: Relationship:
Name: Age: Relationship:

Who will be the primary caretaker of the new dog?

Is everyone in the household agreeable to a new dog?  Yes No

Does anyone in the household have allergies or asthma? Yes No

If you have frequent visitors, do you have a way to separate your dog from them if it is uncomfortable?

Yes No

Explain:

Type of Residence: 

Do you live in a "Deed Restricted" area?

Landlord Information (only if you rent or lease):

Name:
Address:
City: State: Zip:
Phone:

Do you have a yard? Yes No

 Is it fenced? Yes No Size of Yard: 

 

If you do not have a yard, how do you plan to exercise the dog?

Do you feel it is acceptable to let your dog off-leash in an open area? Yes No

Have you ever housetrained a dog before? Yes No

If so, what method did you use?

 

Are you willing to housetrain? Yes No

Where will your dog be kept during the day?

 

Where will your dog be kept at night?

 

Are you interested in crate training? Yes No

How long will your dog be left alone during the day?

 

Have you owned any dogs during the last 10 years? Yes No

If so, tell us about them:

What types of personalities do you find desirable in a dog?

 

Are you willing to take a dog that is:

Not reliable with children? Yes No Physically handicapped? Yes No
Requires ongoing medication? Yes No Requires housetraining? Yes No
May have been abused? Yes No

Are you willing to adopt a bonded pair? Yes No

Do you currently own pets? If so, please list them:

Pet's name Breed Age Years
owned		 Gender Fixed Bred Kept
Female
Male		 Yes
No		 Yes
No 		Indoors
Outdoors
Female
Male		 Yes
No		 Yes
No 		Indoors
Outdoors
Female
Male		 Yes
No		 Yes
No 		Indoors
Outdoors
Female
Male		 Yes
No		 Yes
No 		Indoors
Outdoors
Female
Male		 Yes
No		 Yes
No 		Indoors
Outdoors

Will your pets accept a new dog into the household? Yes No

Are your pets current on vaccines? Yes No

Are your pets current on heartworm preventative? Yes No

What type of heartworm preventative are they on?

Have you ever given up an animal before?

If yes, explain why:

Please list your vet's information:

Name:
Address:
City: State: Zip:
Phone:

Please provide 3 references:

Name Phone Relationship Years known

By completing this application and signing below and pressing the submit button, I certify that I am at least 21 years of age and will assume all responsibility for the care and well being for the animal that I am adopting through UnderDog Rescue of Florida.

I further agree that I will be contractually bound through adoption to:

  • Take my dog to the vet at least once a year for an annual exam, shots, and heartworm check.
  • Take my dog to a vet in a timely manner if ill.
  • Maintain proper care, including monthly heartworm prevention and flea/tick treatments.
  • Return my dog to UnderDog Rescue of Florida and ONLY UnderDog Rescue of Florida if for any reason I can no longer care for the dog in a loving and humane manner.

Please note that we must be given notice of 3 weeks to arrange to take a dog back.

Signature:    

Today's Date:

 
UnderDog Rescue of Florida, Inc.
Bradenton, Florida
Phone: 941-776-7370
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