Name

Address
City State Zip

Phone
E-mail

Age

Why do you want a dog?

Please describe, in detail, your ideal pet. Tell us what your lifestyle is like, what you plan to do with your pet, and how you hope the new pet will fit in with other members of the household.

If there is a specific dog you are interested in, please write his/her name here:

Would this be your first dog as an adult? Yes No

What kinds of pets have you had in the past?

Which of these do you still have (include age and sex).

Have you ever had a litter born at your home?  Yes No

Have your current pets been spayed or neutered? Yes No Some

Are they current on vaccinations? Yes No Some

What happened to the ones you no longer have?

Have you ever had at pet euthanized?    Yes No

If yes, please explain:

Have you ever turned a pet into a shelter, re-homed a pet on your own, or released one to a rescue group?       Yes No

If yes, please explain:

Do you have experience training dogs in basic skills such as housebreaking, leash walking, etc? Yes No

If not, are you willing to actively seek knowledgeable help for this training? Yes No

Are you interested in receiving information about local trainers and obedience/socialization classes? Yes No

Was your last dog obedience trained? Yes No

How many adults are there in your family?

How many children?

Children's ages

Have you ever given a pet up because of a new baby in the house? Yes No

Do you anticipate any/more children in the future? Yes No

Does any member of your household suffer from animal-related allergies? Yes No

If yes, please tell us what types of animals you are allergic to and how you plan to cope with those allergies with a new pet:

How many hours each day will the dog be without human companionship?

Please explain what you plan to do for the dog while you are away:

Do you live in a: house apartment townhouse mobile home

Do you own or rent your home? own rent

If you rent, please provide the owner’s name and phone number.

Do you have a completely fenced yard Yes No

What kind of fence?

Height?

If you do not have a yard, please explain how you will handle outdoor activities with your dog

Would you be willing and able to exercise your dog on a regular basis Yes No

How?

Are there times when the dog will be tied up Yes No

If yes, when and for how long

If your new dog displays a tendency to jump the fence in your yard, what will you do?

If your new dog is not housebroken, what method will you use to train him/her?

Are you familiar with crate training?  Yes No

Will you keep your dog up-to-date on vaccinations? Yes No

Do you have an existing relationship with a veterinarian? Yes No

Please provide vet’s clinic and phone number:

Where will your dog be kept during the day?

Where will your dog be kept at night

Where will your dog sleep?

If you drive a pick-up truck with an open bed, will your dog ride in the back? Yes No

If you move, will you take you dog with you? Yes No

Will you ensure that your new home has no breed, size, or other restrictions that will affect your pet prior to moving?  
Yes No

Have you ever given a pet up because you had to move?  Yes No

If yes, please explain:

What will you do if the cost of taking care of your pet exceeds what you anticipated

Have you ever applied to adopt a dog from BDAR in the past? Yes No

Please tell us when and who you adopted:

Are you willing to allow a BDAR representative to see where your dog will be living? Yes No

Are you willing to take responsibility for your dog for the next 10-15 years Yes No

Where did you hear about BDAR?

If you are approved for adoption, and after your new family member is settled in, would you be interested in becoming a foster parent for other death-row dogs saved by BDAR?   Yes No

Is there anything else you would like us to know?