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Dog Adoption Application
Name
Email
Please confirm.
Check to confirm that you understand that you are requesting a dog in
FORT SMITH, NORTHWEST TERRITORIES, CANADA.
Physical Address
Mailing Address
Town/City
Territory/Province
Postal Code
Phone Number
Alt Phone Number
Who are you adopting this pet for?
Who will be the primary care giver for this pet?
How many adults live in this home?
How many children live in this home?
Who are the regular visitors to the home (human/animal) with whom this pet must get along with?
Is anyone in the home allergic to dogs?
Yes
No
Uncertain
Have all the family members been introduced to the dog?
Yes
No
Some
Describe why you believe this will be a great forever home for this dog.
How much time and thought has gone into the decision to adopt a dog?
How much time and effort are you prepared to put into caring for this dog? What are the responsibilities of a dog owner?
Do you own any other pets?
Yes
No, but I have in the past
No, I never have
Other:
Are the other pets in your home spayed/neutered?
Yes
No
Not Yet
Will your other pets get along with this dog?
Yes
No
Not Sure
Please identify the species, breed, sex, and age of all other pets currently living in your home.
Do you currently have a veterinarian?
Yes
No
Not Yet
Can we contact your vet?
Yes
No
Not Yet
How many dogs have you owned in the past five years?
Where did you obtain these dogs?
What happened to these dogs? (Be specific)
Have you ever surrendered an animal?
Yes
No
Have you ever had an animal taken away from you?
Yes
No
Have you ever lost an animal or had one run away?
Yes
No
Have any of your animals ever been injured or killed by a person, another animal, an accident, etc?
Yes
No
What is the dog’s name that you are interested in adopting? * If you do not have a specific dog in mind please identify preferred breed, gender, etc.
Explain why you are interested in this specific dog/breed?
What are the reasons you would like to adopt this dog?
Human Companionship
Animal Companionship
Protection
Hunting
Agility
Other:
Where will the dog spend the day?
Loose indoors
Loose outdoors
Crate
Kennel Run
Basement
Garage
Fenced Yard
Tied Up Outside
Other:
Where will the dog spend the night?
Loose indoors
Loose outdoors
Crate
Kennel Run
Basement
Garage
Fenced Yard
Tied Up Outside
Other:
On average, how many hours per day will the dog be alone?
Describe your travel patterns. For example, describe how often are you away from home, for how long, for what reasons. Include travel for work, home, medical, etc.
How will you ensure the dog is looked after while you are away?
What behaviour problems are you willing to tolerate and work on?
Barking
Chewing
Separation anxiety
House breaking problems
Jumping up
Shedding
Digging
Property damage
Mouthing
Aggression
How would you resolve these problems?
Under what circumstances would you surrender this dog?
Moving
New Baby
Divorce
Illness
New Relationship
High Cost of Child Care
Allergies
Vacation
Retirement/Loss of Job
Dog's Behaviour
Does not get along with other pets
None of the above
Other:
Have you ever surrendered any pet to an SPCA or other organization?
Yes
No
Have you ever been charged with cruelty or neglect to animals?
Yes
No
Are you aware of the animal bylaws in your community?
Yes
No
How much do you estimate the veterinary costs will be for this dog and can you afford it?
Do you live in a:
House
Apartment
Trailer
Condo
Shared
Other:
Do you own or rent where you live?
Own
Rent
Live with owner (ex. live with a relative but do not pay rent)
Other:
If you rent or live in home that you do not own, do you have the owner's/landlord's permission to have a dog?
Yes
No
Not yet but I will get it
How long have you lived here?
Do you have a fenced yard?
Yes
No
How will you handle your dog's exercise needs?
How will you handle your dog's toilet requirements?
Are you willing to allow a representative of the the FSAS or SPCA in your community visit your home by appointment?
Yes
No
Have you made arrangements to spend a few days at home with this dog while it gets accustomed to its new home?
Yes
No
Falsified Responses
Please check to acknowledge that you are aware that falsified responses will lead to automatic rejection of this application.
Complete Responses
Please check to acknowledge that you have answered all questions on this application truthfully to the best of your understanding.
Please type your name here as a way of signing your application.
Submit