First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Alt Email

What is your age?*
Choose one: Under 18 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older

Do you own, rent, or live with your parents?*
Choose one: Own Rent Live w/ Parents

Type of residence*
Choose one: House Apartment Farm Other

Residence other:

Landlord name

Landlord Phone #

Number of people in the household:

Ages of those under 18:

Please list ALL pets you currently own or have owned in the last 5 years:

Pet 1: Pets Name, type of animal, gender, age, breed, spay/neuter status

Pet 1: Current on vaccinations? Lives indoors, outdoors, or both? Still own? If not, why?

Pet 2: Pets Name, type of animal, gender, age, spay/neuter status.

Pet 2: Current on vaccinations? Lives indoors, outdoors, or both? Still own? If not, why?

Pet 3: Pets Name, type of animal, gender, age, spay/neuter status.

Pet 3: Current on vaccinations? Lives indoors, outdoors, or both? Still own? If not, why?

Pet 4: Pets Name, type of animal, gender, age, spay/neuter status.

Pet 4: Current on vaccinations? Lives indoors, outdoors, or both? Still own? If not, why?

Additional Pets: Pets Name, type of animal, gender, age, spay/neuter status

Additional Pets: Current on vaccinations? Lives indoors, outdoors, or both? Still own? If not, why?

Name of pet interested in adopting.
Choose an animal: Annie Bella Drako Dutchess Elliott Jacob Jed Jessie Jet Jobe Joe Josie Journey Luna Molly Oliver Preacher Shelby Sully Tinker Wyatt Wyatt B “J” litter ~ Females “J” litter ~ Males

Do you currently have a veterinarian?
Choose one: Yes No

Who is your veterinarian (provide name & phone number)?

If a puppy, do you plan to have the dog you adopt spayed or neutered?
Choose one: Yes No

What made you decide to adopt a dog?

How do you plan to transport your dog?

Do you or your neighbors own livestock or exotic animals?
Choose one: Yes No

How much do you expect to spend on your dog each year?
Choose one: $50-100 $100-200 $200-300 $300-400 $400-500 $500+

I have owned a dog before:
Choose one: Yes No

My dog will be primarily:
Choose one: Inside Only Outside Only Inside and Outside

What type of fence do you have around your yard? If no yard, where would you take the dog for exercise?

How many hours per day will your dog be outside?

When I am not home, my dog will be:
Choose one: In a crate In the yard On a cable run In a kennel In the garage Loose in the yard Other

Other describe:

In general, my dog will be without human companionship hours per day:
Choose one: less than 2 hours 4 to 6 hours 8 to 10 hours 12 hours Other:

Other, describe:

My dog needs to get along with:

Other animals, describe:

What level of training are you willing to provide to your new dog to help improve manners such as pulling on the leash or jumping?

Are you interested in adopting a dog with special needs (either medical or behavioral)?
Choose one: Yes No Maybe

Check below the qualities of your perfect canine companion:

Reference 1: Name, relationship, phone number*

Reference 2: Name, relationship, phone number*

Reference 3: Name, relationship, phone number

I certify that my information is true and understand that any false information will nullify the adoption. I agree to a pre-/post-adoption home inspection by a Texas All Creatures Rescue Volunteer. I understand that Texas ACR reserves the right to refuse any adoption.*
Choose one: I Agree