Adoption Application

To help ensure the best possible placement of our rescued dogs, and in order to determine that the proposed adoption is in the best interest of the dog, you, and your family, please complete each of the following questions. Please be as thorough as possible. The Brockton Blue Dog Shelter reserves the right to refuse adoption to any applicant. Once the form is completed, you may may simply submit via email by choosing the submit button, or you may print it out and sign it and fax to (508-584-7801) or mail to (1014 Pearl Street, Brockton, MA 02301), or drop it by the shelter.

Adoption Animal

Which adoption animal prompted you to apply?

Personal Information

First Name

Last Name

Spouse's First Name

Spouse's Last Name

Home Phone

Work Phone

Cell Phone

Email Address

Street Address

City

State

Zip Code

Employment

Occupation

Years Employed

Employer

Employer's Phone Number

Your Home

What type of home do you live in?

House
Apartment
Condominium
Duplex
Mobile Home

Do you own or rent?

Own
Rent

If you rent does your lease allow dogs?

Yes
No

Landlord's Name

Landlord's Phone Number

Length of time at current residence?

Less than 1 year* (If selected, please provide previous address)
1-3 years
3-5 years
5+ years

Previous Address*

Is your property fenced?

Yes
No

If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties?

Do you have a swimming pool?

Yes
No

How many adults live in your home?

How many, if any children live in your home?

What are their ages?

Does anyone living in your home have allergies?

Yes
No

If they do, how do you plan to accommodate your new pet?

Does anyone in your home have physical disabilities?

Yes
No

If yes, please explain

Are all family members aware that you are considering adopting a dog?

Yes
No

Do they approve?

Yes
No

Other Animals

Please list all dogs and cats you currently own or have owned in the past three years.

Animal 1

Name

Type/Breed

Sex

Male
Female

Age

Neutered/Spayed?

Yes
No

Length of ownership

If no longer owned, please explain

Animal 2

Name

Type/Breed

Sex

Male
Female

Age

Neutered/Spayed?

Yes
No

Length of ownership

If no longer owned, please explain

Animal 3

Name

Type/Breed

Sex

Male
Female

Age

Neutered/Spayed?

Yes
No

Length of ownership

If no longer owned, please explain

References (No Relatives)

If you have listed other pets, you must provide Veterinarian information in addition to (3) personal references (no relatives).

Veterinarian

Phone

1st Personal Reference

Relationship

Phone

2nd Personal Reference

Relationship

Phone

3rd Personal Reference

Relationship

Phone

A Dog's Life

Will there be someone home with your dog during the day?

Yes
No

What is the greatest number of hours the dog will spend alone daily/nightly?

Where will the dog spend most of its time?

Crate
Indoors
Outdoors
Garage
Basement
Run

Where will your new dog's main sleeping quarters be?

Crate
Dog bed
Share bed with owner
Designated Room
Outdoors
Garage
Basement

Is there someone home at night?

Yes
No

Do you plan to travel with the dog?

Yes
No

If not, where will the dog stay while you are away?

Friend or Family
Kenneled
In home pet-sitting

Have you ever taken a dog to obedience classes?

Yes
No

Have you ever crate trained a dog?

Yes
No

How much do you think this dog will cost you each year? (please include food, heart worm preventative, flea control, medicine, medical and dental care, supplies, training, grooming, boarding costs, and toys)? $

Have you ever given up a pet for adoption?

Yes
No

If yes, please explain the circumstances

Have you or anyone else in your home ever been convicted of OR charged with cruelty to animals, child abuse or domestic violence?

Yes
No

Desired Animal

What type of animal are you looking for?

What sex animal are you looking for?

Male
Female
No Preference

What age animal are you looking for?

Would you accept a dog that has a treatable medical condition?

Yes
No

What type of activities do you plan for you and your dog?

I certify that I have read and completed the Adoption Application completely and accurately.
___________________________________________ (If mailing or faxing completed form)
Signature

I am over the age of 18, or have parental permission to adopt an animal. By submitting this form, I agree that it was completed accurately and completely.

Agree to Terms