about us | contact us | donate
  view Dogs Adopt a Dog Contribute Resources Forum AboutUs contact us

Adoption Application for Affinity Rescue - Use the tab key to move from field to field.   The enter key will submit the application, but if unfinished, use the back key and your information will be saved on the form.  If you have any questions email us at : affinityrescue20@yahoo.com

First Name:   Last Name:  
Primary Telephone:   ( ) - Additional Phones:  
Primary E-mail:   2nd E-mail:  
Street Address:   City:  
State:   Zip Code:  

List Dog(s) of Interest:

Please tell us why you want to adopt this specific dog.

What are your primary reasons for wanting a dog? List all that apply.

E.g.: hunting, for children, companionship, mouser, guard dog, farm work, breeding, as a gift, or other reason.

Please tell us about your plans to care for the dog.

E.g.: using crates, obedience classes, housebreaking, exercise, shedding.

Where do you plan on keeping the dog you are adopting?

E.g.: In the house, in a crate, in an outside kennel, in a barn, in a garage, tied up outside, outside loose, in a fenced yard, or other situation.

How will the dog be left alone when you are away from home?

What will happen to the dog if you move?

How would you describe your level of experience with Dogs? (new dog owner, intermediate, experienced) Please explain answer.

What do you consider is an acceptable reason for giving up a pet?

What is the longest the dog would be left alone each day?

Do you rent or own?     Type of home?  

If renting, please provide your landlord's name and phone number:

Please list the names and ages of each household member.
Place an asterisk (*) next to the primary caretaker.
Note any known allergies.

Please describe the yard / outside space for your living arrangements.

Please list the pets you have cared for in the past five years (please put an asterisk * by current pets). Include the following: species, name, sex, sterilization, how long you have cared for the pet. If the pet is no longer with you, indicate why.

For each pet currently in your household, please list their vaccination and exam status.

Is there anything else you'd like to tell us about yourself?

Are you financially prepared to afford the veterinary fees and unexpected costs?


Please include the name and phone number (and e-mail address if available) of two references and your veterinarian. Please notify your references before they are contacted!


Reference #1

Reference #2

By signing below, with my initials, I certify that all the above information is true to the best of my knowledge and I recognize that any misrepresentation will result in the loss of adoption privileges. I authorize investigation of all statements in this application and understand that the Veterinarians, other Shelters, Landlords, etc. will be contacted.

Affinity Rescue reserves the right to refuse any application without explanation.

Enter Your Initials:
This is your signature.


view dogs | adoption application | donate | testimonial | about us
contact us | dog of the week | adopt a dog | Sponsors | home