NAME(s) and BREED(s) OF DOG that interest you: (REQUIRED)

APPLICANT INFORMATION
Your Name:
Phone (Work): Phone (Home): Phone (Cell):
What is the best time and number to reach you?
Address:
City: State: Zip:
Preferred Email Address:
Are you over 21? yes ... no
Occupation:
Employer Name and Address:

HOUSEHOLD INFORMATION
Number of Adults in Household:
For all adults in household in addition to applicant, please provide information:
1. First and Last Name:
Occupation:
Employer Name and Address:
2. First and Last Name:
Occupation:
Employer Name and Address:
3. First and Last Name:
Occupation:
Employer Name and Address:
Number of Children in Household: Ages of Children:
How did you hear about BARK?
Short Pump Adoption Event
Fredericksburg Adoption Event
Previous Adopter
Online
Friend
Newspaper
Other: 
Are you aware of your county’s or city’s number of pets you can have in your home? yes ... no
Is this the first dog for you and/or your family? yes ... no
Are all the adults in your household aware that you are adopting a dog/puppy? yes ... no
Who will be the primary caregiver for your new dog/puppy?
Does any member of your household have an allergy to dog hair/dander? yes ... no
If adopting, what do you hope that a new dog/puppy will add to your lifestyle?
If you presently have other animal(s), please describe:
1. Name: Breed: Age: Gender:
Spay/Neutered? yes ... no
Current on vaccinations? yes ... no
2. Name: Breed: Age: Gender:
Spay/Neutered? yes ... no
Current on vaccinations? yes ... no
Others?
Who is financially repsonsible for your current pets?
Name of your veterinarian:
Location of your veterinarian (city/town):
Veterinarian’s phone number with area code:
In whose name are these veterinary records?
Is there any additional information about your current pets that you would like us to know?
If you have previously had other animal(s), please complete:
1. Name: Breed: Years Owned:
Spay/Neutered? yes ... no
Where is this pet now?:
Name of veterinarian for this pet:
Location of this veterinarian (city/town):
This pet’s veterinarian phone number with area code:
2. Name: Breed: Years Owned:
Spay/Neutered? yes ... no
Where is this pet now?:
Name of veterinarian for this pet:
Location of this veterinarian (city/town):
This pet’s veterinarian phone number with area code:
Who was financially repsonsible for these pets?
In whose name are these veterinary records?
Others?
How did you correct the animals listed above, if they had an accident in the house?

The next three questions apply to all adults residing in the house.
Has anyone in your household EVER released a pet to an animal shelter or rescue? yes ... no
Has anyone in your household EVER given a pet away? yes ... no
Has anyone in your household EVER sold a pet? yes ... no
If answered yes to any of the previous three questions, what were the circumstances?
Is there any additional information about your previous pets that you would like us to know?

LIFESTYLE INFORMATION
Please select the temperament and activity level you are seeking in a dog (select all that apply):
Athletic/High Energy
Quiet
Lap-dog
Mellow
Very Affectionate                 
What type of housing do you live in (detached, town house, apartment, etc.)?
Do you own or rent?
If renting, what is your Landlord’s policy on pets?
If renting, what is your Landlord’s name: Phone number with area code:
Do you have a completely fenced yard? yes ... no
If yes, what is the type and height of the fence?
Is there a gate? yes ... no
Do you have a pool? yes ... no
If yes, is there a fence around it? yes ... no
How many hours each day will the dog/puppy be left alone?
Will the dog/puppy be kept indoors or outdoors when alone?
Will the dog/puppy be crated? yes ... no
In what room will the puppy/dog be kept?
Where will the dog be kept during the day when you are home?
Where will the dog sleep at night?
What type of exercise will you give your dog?
How often?
How many hours a day do you realistically have to exercise or play with your dog?
Are there times when the dog will be tied outside? yes ... no
If yes, when?
If adopting, do you plan on attending obedience classes with your new dog/puppy? yes ... no
What methods will you use to train your new dog/puppy?
If your new dog/puppy has an accident in the house, how will you correct him/her?

How long do you expect housebreaking to take?
Do you know what causes heartworms in dogs/puppies? yes ... no
Do you agree to keep your dog on heartworm preventative year round? yes ... no
When you go on vacation/travel, who will care for the dog/puppy?
If you move, what will you do with the dog/puppy?
How much are you willing to spend on medical bills for the dog/puppy?
What would you do if the vet bills go over this amount?
Have you ever incurred extraordinary vet expenses? yes ... no
If so, please explain:
Are you ready to take responsibility for this dog for the next 10–15 years? yes ... no
What provisions will you make for the dog should you become unable to care for it?
Have you previously applied to adopt a dog, puppy, cat or kitten from a rescue or shelter? yes ... no
If yes, when did you apply, and what was the name of the rescue or shelter?
What was the result of your application?
Are you willing to have a BARK representative visit where the dog/puppy will be living? yes ... no
Personal Reference of someone not living in your home
1. Name: Phone number: Relationship
2. Name: Phone number: Relationship

Is there anything else you feel we should know?


AUTHORIZATION/RELEASE
By signing (placing your initials on this form) below and submitting this form, I certify that all information given in this application is true and correct, to the best of my/our knowledge. I understand that BARK is a non-profit organization and is offering the Rehoming Assistance Program as a RESOURCE to help animals in need and is in no way responsible or affiliated with the dog or lister/owner of the dog. By submitting this form, I hereby further grant consent to BARK and its agents to seek information about me from all named and unnamed sources within this application, including but not limited to veterinarians, rental agents, and personal references, regarding this application. Providing false information or refusing to sign below will result in the rejection of the application or the nullification of any adoption or foster agreement.

Signature of applicant (enter your initials): (REQUIRED)

Signature/initials of second applicant (if applicable):