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Adoption Application

ALL FIELDS ARE MANDATORY.  Please put NA if not applicable.

– We recommend you complete this form on a desktop/laptop computer for ease of use.
– Answer all questions.
– Please do not submit an application until you see a specific dog that interests you.
– Incomplete applications and applications that do not include a specific dog may not get processed.

    CONTACT PERSON




    Have you ever applied with Polka Dogz Pet Rescue?
    YesNo
    IF YES: When?

    Have you ever been convicted of a felony?
    YesNo
    IF YES:




    Have they ever applied with Polka Dogz Pet Rescue?
    YesNo
    IF YES: When?

    Have they ever been convicted of a felony?
    YesNo
    IF YES:

    ADDRESS





    HOME ENVIRONMENT


    Do you own or rent?
    OwnRent

    Do you have a property management company, landlord or rental office?
    YesNo
    IF YES:

    Do you have a fenced yard?
    YesNo
    IF YES:

    Do you have a pool?
    YesNo
    IF YES:
    Does it have a child safety fence around it?
    YesNo
    Could a small dog get out of the pool on its own?
    YesNo

    How many people live in your home?

    Do you have children under 18 living in your home?
    YesNo
    IF YES:

    PET OWNERSHIP HISTORY

    Have you ever had a dog that you returned or re-homed to somewhere else?
    YesNo
    IF YES:

    Do you have any pets currently?
    YesNo
    IF YES:

    Have you had any pets in the past?
    YesNo
    IF YES:

    IF YES:
    Please provide your most recent veterinarian information


    Are your current pets, or were your previous pets, spayed or neutered?
    YesNo
    Are your current pets, or were your previous pets, on heartworm prevention?
    YesNo

    REFERENCES

    Reference 1




    Reference 2




    Reference 3



    PET CARE

    If you can no longer care for your pet, who will?



    What is your employment status?


    How will you discipline your dog?

    Where will the dog stay while you are home?

    Where will the dog stay when you are NOT home?

    Where will the dog stay if you go out of town?

    Where will the dog sleep?

    How do you feel about a dog being on the furniture?

    Do you require that the dog you adopt is already house-trained?
    YesNo
    IF YES:

    Are you looking for a dog that is already crate trained?
    YesNo
    IF YES:

    Have you ever been charged with animal neglect or abuse?
    YesNo
    IF YES:

    Are all people in the household ready for a new dog?

    DOG REQUEST

    What dog are you applying for?

    How did you hear about Polka Dogz? Please be specific.

    I certify that all answers made by me on this adoption application are, to the best of my knowledge, true and correct.
    YesNo

    General Information and Guidelines

    All adoption applicants will be interviewed, have a home visit completed and approved before potential adoption.  Polka Dogz Pet Rescue reserves the right to deny any applicant.  All questions MUST be answered in their entirety or your application will not be submitted.

    • We seek fellow animal lovers, who are committed to providing the very best care for their pet as they would for any member of the family.
    • Must be 21 years of age or older in order to adopt.
    • We only adopt to those residing in the state of Florida. No out of state adoptions.
    • Current and recent pet owners Must provide a vet reference showing preventative care.
    • Excellent veterinarian reference showing history of shots and heartworm prevention.
    • No animal will be tied up, kept in a doghouse, pen, run, or kennel, or any type of garage, shed, laundry room, or basement.
    • Landlords or rental agents will be called to verify pets are allowed.
    • We keep an ongoing relationship with our adopting families and reserve the right to visit the pet’s home by appointment to verify the pet’s well-being.
    • Filling out an application does not guarantee adoption, nor does it obligate you to adopt.
    • An adoption fee is required at the time of adoption
    • We are not “first come first served”.  We strive to pick the best home for each of our pets.

    ADOPT… DON’T SHOP

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