Page 1 of 13 Dog Adoption Application Form What is the name of the DOG you are interested in adopting? (not your name)* Invalid Input Today's Date* Invalid Input What is your timeframe for adopting a dog?* I want to adopt right away and will bring the right dog into my home as soon as possibleI have a few things coming up and might be ready to adopt in a few weeks but not right awayI am just seeing what is out there, please keep my app on file Invalid Input Next > Primary Adopter Information Full Name:* Please type your full name. E-mail:* Invalid email address. Cell Phone Number:* Invalid Input Birthday - MONTH and YEAR only (min age to adopt is 21)* Invalid Input Street Address:* Invalid Input City:* Invalid Input Please note OUR ADOPTION RADIUS is in Chicago and in the surrounding suburbs (mostly Northern IL, and at our discretion WI and IN areas). Please DO NOT COMPLETE THIS APPLICATION if you live out of our adoption radius - the response will be that you are out of the adoption radius. State:* Invalid Input Please note OUR ADOPTION RADIUS is in Chicago and in the surrounding suburbs (mostly IL, rarely WI and IN areas) Please DO NOT COMPLETE THIS APPLICATION if you live out of our adoption radius - the response will be that you are out of the adoption radius. Zip Code:* Invalid Input < PrevNext > Employment Information Employer:* Invalid Input Current Position:* Invalid Input < PrevNext > Secondary Adopter Information Full Name: Please type your full name. Relationship to Primary Adopter: Invalid Input Birthday: Month and Year only Invalid Input E-mail: Invalid email address. Cell Phone Number: Invalid Input Street Address: Invalid Input City: Invalid Input State: Invalid Input Zip Code: Invalid Input < PrevNext > Secondary Adopter Employment Information Employer: Invalid Input Current Position: Invalid Input < PrevNext > Residence Information Number of years at residence:* Invalid Input If less than 1 year, what was your prior address? Invalid Input Type of Property:* House (Single-Detached)TownhouseApartmentCondoMobile HomeOther Invalid Input If "Other", please indicate type of property: Invalid Input Do you Own or Rent your home?* Do you Own or Rent your home?OwnRent Invalid Input If you rent- Landlord/Complex Name: Invalid Input If you rent- Landlord/Complex Phone Number: Invalid Input If you rent- Are you allowed pets? If you rent- Are you allowed pets? YesNo Invalid Input If you rent: Are there any pet restrictions? Please describe breed, size and other restrictions and be prepared to send us the pet policy in your lease. We will ask for it. : Invalid Input Do you plan to move within a year and if so, where?* Invalid Input < PrevNext > Family Information Number of adults in household:* Invalid Input Ages and Relationships of Adults in Household:* Invalid Input Number of children in household:* Invalid Input Ages and Relationships of Children in Household:* Invalid Input List the age and relationship of anyone else who may be a frequent guest in your home (ie, grandkids who regularly visit, kids you babysit, a partner or relative who stays often but doesn’t live there). * Invalid Input Is anyone in your household allergic to animals?* Is anyone in your household allergic to animals?YesNo Invalid Input If yes, who and to what type of animal. Otherwise, type NONE: Invalid Input < PrevNext > Pet Caregiving If you have to move in the future, what will you do with your pets?* Invalid Input Who in the household will be the pet's primary caregiver?* Invalid Input What are your beliefs regarding spaying/neutering?* Invalid Input Please list all the dogs and cats you have owned as an adult. NAME | BREED | AGE | SEX | NEUTERED/SPAYED | DECLAWED | LIVING/DECEASED | If no longer living with you and still alive, why and where are they If this is your very first pet as an adult, please type NONE.* Invalid Input Have you ever turned an animal in to a shelter?* Have you ever turned an animal in to a shelter?YesNo Invalid Input If you have returned a pet to a shelter, please explain: Invalid Input Who is your Veterinarian? We will contact your vet. Please send the correct number for the vet who can verify medical history for all pets in the past 5 years* Invalid Input Veterinarian's City:* Invalid Input Veterinarian's Phone Number:* Invalid Input Are all you're pets up to date on vaccinations and heartworm testing? We WILL CALL YOUR VET to verify a history of vaccination and heartworm prevention.* Invalid Input Are all dogs and cats in your home spayed or neutered? Animals in your home MUST BE ALTERED before adoption and we will call your vet to confirm this. * Invalid Input < PrevNext > Lifestyle Information Have you adopted from Starfish Animal Rescue in the past?* Have you adopted from Starfish Animal Rescue in the past?YesNo Invalid Input Describe your ideal pet / Why do you want to adopt?* Invalid Input What kind of pet are you looking for?* What kind of pet are you looking for?IndoorOutdoorBoth Invalid Input Where will the pet be when you're home?* Invalid Input Where will the pet sleep at night?* Invalid Input Where will the pet be when you're NOT home?* Invalid Input What activity level would you like your pet to have?* What activity level would you like your pet to have?LowMediumHigh Invalid Input How many hours a day will your pet be alone?* How many hours a day will your pet be alone?0-2 hours3-6 hours7-9 hours10+ hours Invalid Input Please provide a brief explanation of alone hours for example, is this every day or only some days? What mid day plan if any do you have in place? * Invalid Input How will you entertain/exercise your pet?* Invalid Input Do you have a fenced yard?* Do you have a fenced yard?YesNo Invalid Input If YES, please describe the height and type, (ie, 6 ft privacy fence, invisible fence etc..) If you use an invisible fence describe the training process. Invalid Input If you do not have a fenced yard, how will you keep the animal on your property? Invalid Input < PrevNext > Training Information How will you introduce your new pet to other animals in the household. If no other pets, type NONE:* Invalid Input How much time are you prepared to allow for your new pet to adjust to your home and other animals? If no other pets, type None:* Invalid Input What is the best way to correct your pet’s mistakes?* Invalid Input If you are applying to adopt a puppy under 6 months old, please include any puppy management plan you have to care for them since young puppy needs vary from an adult. (include N/A if applying for an older dog)* Invalid Input Will you be enrolling your dog/puppy in obedience class?* Will you be enrolling your dog/puppy in obedience class?YesNo Invalid Input If yes, where will you enroll them? Invalid Input If you won't be enrolling your dog/puppy in obedience, why not? Invalid Input Have you previously trained a dog/puppy?* Have you previously trained a dog/puppy?YesNo Invalid Input If yes, what is the name of the facility/trainer you used? Invalid Input Have you used a prong, e-collar, or slip/choke collar as part of training? * Have you used a prong, e-collar, or slip/choke collar as part of training? YesNo Invalid Input If you answered YES to using any of the above devices, please provide details on use, If you answered NO please type NA* Invalid Input Are you familiar with crate training?* Are you familiar with crate training?YesNo Invalid Input Are you familiar with house training?* Are you familiar with house training?YesNo Invalid Input What training methods do you plan to use with your new dog/puppy? Please describe what "Positive Reinforcement" means to you. * Invalid Input What types of socialization opportunities will your dog/puppy have?* Invalid Input < PrevNext > Pet Characteristic Information Which characteristics would you not tolerate in a pet?* Which characteristics would you not tolerate in a pet?Not housebroken right awayDog aggressiveCat aggressiveToo hyperDiggerFence jumperBarkerDroolerProtective over food/toysNot housebroken after trainingNone Invalid Input If a characteristic you would not find tolerable was not available in the previous list, please explain: Invalid Input Under what circumstances would you return an animal to our rescue?* Under what circumstances would you return an animal to our rescue?Moving across state/into apartment Lost job/can no longer affordBehavioral issues (i.e., dog aggression, etc.)Health issues (i.e., hip displasia, etc)Having kidsGets too bigAllergiesNone Invalid Input If a circumstance for returning an animal to our rescue was not in the previous list, please explain: Invalid Input < PrevNext > Owner Responsibility Are you prepared to assume the financial responsibilities of providing your pet with adequate food, training, toys, routine and emergency medical care etc. (approx. $1,000+ per year)?* Are you prepared to assume the financial responsibilities of providing your pet with adequate food, training, toys, routine and emergency medical care etc. (approx. $1,000+ per year)?YesNo Invalid Input Are you committed to providing a responsible home for your pet’s entire life (could be 18+ years)?* Are you committed to providing a responsible home for your pet’s entire life (could be 18+ years)?YesNo Invalid Input If you are 65 or older, do you have plans for the dog to be cared for in case of unexpected life circumstances? Please describe: * Invalid Input How did you learn about Starfish Animal Rescue?* How did you learn about Starfish Animal Rescue?FacebookInstagramFriend/FamilyAdoption EventPetfinderAdopt A PetPrior AdopterSupporterStarfish WebsiteOther Website Not ListedOther Invalid Input Are you willing to sign a legal contract agreeing to pet owner responsibility?* Are you willing to sign a legal contract agreeing to pet owner responsibility?YesNo Invalid Input I understand that Starfish Animal Rescue will only use this information to contact me to help me find a forever home for one of their pets.* I understand that Starfish Animal Rescue will only use this information to contact me to help me find a forever home for one of their pets.YesNo Invalid Input < PrevNext > Agreement By entering my FULL NAME and DATE below, I certify that the information provided is complete and correct. I realize that any misrepresentation of fact may result in my losing the privilege of adopting an animal. I understand that Starfish Animal Rescue has the right to deny my request for adoption. I authorize verification of all statements on this application including but not limited to prior vet medical history. I understand that this application is the property of Starfish Animal Rescue who reserves the right to share this information with other shelters and rescue organizations.* Invalid Input Digital Signature. Use Mouse or Touchscreen to sign below.* Invalid Input Are you a Robot?* Invalid Input < PrevSubmit Adoption Application
