Contact Information
First Name: Last Name:
Mailing Address:
City: State: Zip:
Residence (If different from mailing address):
Home Phone: Work Phone: E-mail:
Why would you like to adopt a former street dog as a pet?: Who will be the primary caretaker(s) of your dog?:
Information About Your Home
How many people currently live in your home? Adults: Children/Age:
Activity level of your household? —Please choose an option—QuietModerately QuietActiveVery Active How many hours per day will your dog be left home alone?
Will your dog be in a crate while you are away? Do you have a dog door? Where will your dog spend its time when you’re away?
Do you agree not to seclude your dog in a garage, basement, laundry room or other area away from the family? —Please choose an option—YesNo Will your dog live primarily indoors? —Please choose an option—YesNo How much time, if any will your dog spend chained outside?
Where will your dog sleep at night? If you do not have a fenced yard, are you willing to take your dog out on a leash as needed, even in the winter? Please describe your housing situation (check all that apply): Rent Own Two Story Fenced Yard (not required) Other:
** If renting, you must have your landlord’s permission to have a dog. Please supply us with your landlord's name, address, phone number and a copy of your lease stating that you are able to have a dog. Landlords Name: Address: PhoneNumber:
Additional Information
How did you hear about Transform A Street Dog?
Please list all animals you currently own: Dog(Breed): Age: Spayed/Neutered:
CATS: binky IndoorOutdoor SpayedNeutered DeclawedNot Declawed
Have any of your pets ever been aggressive towards other animals? If so, please explain.
References
Veterinarian's Name: Veterinarian's Phone Number:
Personal references known for at least 2 or 3 years? (Not relatives) Please list each name and phone number Have you ever adopted a pet from a shelter or rescue group? If so, describe that experience:
Have you ever surrendered an animal to a shelter or rescue group? If yes, when and what for?: Have you ever been charged with an animal-related crime? No If yes, please provide details:
I hereby certify that the above information is true to the best of my knowledge. I approve Co applicant(s) (All adults in home must include electronic signature): I approve
By checking this box, I understand that. Please check box to agree to statements below
Home checks are made if possible. If a home check is not possible, an Adoptions Manager will contact me via email after my application is received to schedule a phone interview to go over my application before I am approved.I will receive an email stating if I am approved. Once I am approved, I agree to send payment at TransformAStreetDog.org/donate for the amount agreed upon within 3 days. The fee will pay for the preparation of my dog for travel, including all necessary documents, immunizations, and for his/her travel expenses. We are a 501c3 so the adoption fee is tax deductible.Once my payment is received, a representative will contact me to finalize travel arrangements for my dog. I agree that I will pick my dog up at the time and location agreed upon. If I cannot make it, I will make arrangements for a trusted friend/ family member to pick up my dog for me. I will contact my Adoption Manager as soon as any change to my plans occur.If I change my mind about adopting my dog after my payment is received, I promise to give at least a 2-week notice. I also agree that in this case, I will not receive a refund for the preparation of my dogs’ travel. I will only receive a refund for the flight.If I am adopting a young puppy and have previously discussed with Transform A Street Dog staff that it is in my dog’s best interest to sterilize him/ her after travel, I promise to have him/ her sterilized in a timely manner and pay for the expenses.If Transform A Street Dog finds information contained in this application to be false, Transform A Street Dog retains the right to turn down my application or remove the animal from my premises without a refund of monies paid.I promise that my dog will be on a leash at all times when he/ she is not in a fenced-in or safe/secure area.I promise that if I ever need to rehome my dog, I will contact Transform A Street Dog and let them know where he/she will be rehomed. It is my responsibility to rehome my dog. I promise that I will not surrender him/her to a kill shelter nor give him/her away to a stranger for free.I agree that Transform A Street Dog will contact me 2 weeks after I have taken custody of my dog to follow up on how we are acclimating.
Would you like to be added to our mailing list? YesNo
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