If you have questions about the Adoption Application, please e-mail [email protected] If you are human, leave this field blank. Thank you for your interest in adopting a rescued dog or puppy. Please Note: 1) Confidentiality: This form is designed to help you find the dog or puppy most compatible with your lifestyle. BARK will maintain the information provided below as confidential and will not share your information with any outside individuals or organizations without your express consent. Completion of this application does not obligate you in any way or guarantee the adoption of a BARK dog or puppy. BARK reserves the right to approve or deny any application for any reason and the right not to disclose the reason. 2) Spay/Neuter: BARK ensures that all adult dogs and puppies are spay/neutered prior to adoption. It is possible that an approved adopter may experience a short waiting period (for spay/neuter to occur) between being approved and being able to take the dog or puppy home. In the event this occurs, we thank you for your patience. 3) Response: A BARK representative will make every effort to contact you regarding your completed application within 3-5 days. When experiencing a high volume of applications, the time to process an application may take longer. Please add “[email protected]” to your list of safe email addresses as all initial communication will come from this email address. Please complete all of the following questions completely to the best of your knowledge. APPLICANT INFORMATION Name(s), size(s), and/or breed(s) of dog that interests you * First and last name * Primary phone number * Phone number type * Mobile Home Work Best time to reach you * Morning Afternoon Evening Weekend Street address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip code * Email address * Are you over 21? * Yes No Occupation * Employer’s name * How did you hear about BARK? Adoption outing Facebook Friend Petfinder Previous adopter Special event HOUSEHOLD INFORMATION Total number of adults in your household * 1 2 3 4 5 6 7 8 9 10 For each adult in the household in addition to the applicant, please provide the following information: INFORMATION FOR ADDITIONAL ADULTS IN THE HOUSEHOLD First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. First and last name, occupation, and employer This information is needed for each adult in the household. HOUSEHOLD INFORMATION (CONTINUED) Number of children in your household * 0 1 2 3 4 5 6 7 8 9 10 Ages of children * Is this the first dog for you and/or your family? * Yes No Are you aware of your county’s or city’s restrictions on the number of pets you can have in your home? * Yes No Are all of the adults in your household aware that you are adopting a dog? * Yes No Who will be the primary caregiver for your new dog? * What do you hope that a newly adopted dog will add to your lifestyle? * Does any member of your household have an allergy to dog hair/dander? * Yes No Have you previously applied to adopt a pet from a rescue or shelter? * Yes No If yes, when did you apply and what was the result of your application? * Number of current animals you have in your household * 0 1 2 3 or more THE FOLLOWING SET OF QUESTIONS SHOULD BE COMPLETED FOR EACH CURRENT ANIMAL IN YOUR HOUSEHOLD. Name of current animal * Breed of current animal * Age of current animal * Gender of current animal * Male Female Is this animal spayed/neutered? * Yes No Is this animal up-to-date on vaccinations? * Yes No THE FOLLOWING SET OF QUESTIONS SHOULD BE COMPLETED FOR EACH CURRENT ANIMAL IN YOUR HOUSEHOLD. Name of current animal * Breed of current animal * Age of current animal * Gender of current animal * Male Female Is this animal spayed/neutered? * Yes No Is this animal up-to-date on vaccinations? * Yes No THE FOLLOWING SET OF QUESTIONS SHOULD BE COMPLETED FOR EACH CURRENT ANIMAL IN YOUR HOUSEHOLD. Name of current animal * Breed of current animal * Age of current animal * Gender of current animal * Male Female Is this animal spayed/neutered? * Yes No Is this animal up-to-date on vaccinations? * Yes No Who is financially responsible for your current animals? * CONTACT INFORMATION FOR YOUR CURRENT VETERINARIAN: Veterinarian’s name * Veterinarian’s phone number * Veterinarian’s address * Please include the street address, city, state, and zip code. In whose name are these veterinary records? * Is there any additional information about your current pets that you would like us to know? Number of PREVIOUS animals you have had * 0 1 2 3 or more THE FOLLOWING SET OF QUESTIONS SHOULD BE COMPLETED FOR EACH PREVIOUS ANIMAL YOU HAVE HAD. Name of previous animal Breed of previous animal Number of years owned Was this animal spayed/neutered? What is the name of the veterinarian who cared for this animal? Veterinarian’s phone number Veterinarian’s address Please include the street address, city, state, and zip code. Who was financially responsible for these animals? In whose name are these veterinary records? Where is this animal now? THE FOLLOWING SET OF QUESTIONS SHOULD BE COMPLETED FOR EACH PREVIOUS ANIMAL YOU HAVE HAD. Name of previous animal Breed of previous animal Number of years owned Was this animal spayed/neutered? What is the name of the veterinarian who cared for this animal? Was this animal spayed/neutered? Yes No Veterinarian’s phone number Veterinarian’s address Please include the street address, city, state, and zip code. Who was financially responsible for these animals? In whose name are these veterinary records? Where is this animal now? THE FOLLOWING SET OF QUESTIONS SHOULD BE COMPLETED FOR EACH PREVIOUS ANIMAL YOU HAVE HAD. Name of previous animal Breed of previous animal Number of years owned Was this animal spayed/neutered? Was this animal spayed/neutered? Yes No What is the name of the veterinarian who cared for this animal? Veterinarian’s phone number Veterinarian’s address Please include the street address, city, state, and zip code. Who was financially responsible for these animals? In whose name are these veterinary records? Where is this animal now? How did you correct the animals listed above if they had an accident in the house? Is there any additional information about your previous animals that you’d like us to know? 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 yes to any of the above, what were the circumstances? * LIFESTYLE INFORMATION Checkboxes * Athletic / High Energy Quiet Lap Dog Mellow Very Affectionate What type of housing do you live in (apartment, detached, townhouse, etc.)? * Do you own or rent your housing? * Own Rent If renting, what is your landlord’s policy on pets? * If renting, what is your landlord’s contact information? * Please include your landlord’s name and phone number Do you have a completely fenced yard? * Yes No If yes, what is the height and type of fencing? * Is there a gate? * Yes No Do you have a pool? * Yes No If yes, is there a fence around the pool? * Yes No How many hours each day will the dog be left alone? * Will the dog be kept indoors or outdoors when alone? * Do you plan on crating your new dog? * Yes No Where will the dog sleep at night? * In what room will the dog be kept when you are home? * What type of exercise will you give your dog? * Are there times when the dog will be tied outside? * Yes No If yes, when? * How often will you exercise your dog? * How many hours a day do you realistically have to exercise or play with your dog? * Do you plan on attending obedience classes with your new dog? Yes No How long do you expect housebreaking to take? * If your new dog has an accident in the house, how will you correct him or her? * Do you know what causes heartworms in dogs? * Yes No Do you agree to keep your dog on heartworm preventative year round? * Yes No When you go on vacation or travel, who will care for your dog? * If you move, what will you do with the dog? * How much are you willing to spend a year on medical bills for the dog? * What would you do if the vet bills go over this amount? * Have you ever incurred extraordinary vet expenses? * Yes No If yes, please explain * Are your 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 him or her? * Are you willing to have a BARK representative visit the home where the dog will be living? * Yes No PLEASE PROVIDE THE NAME AND CONTACT INFORMATION FOR TWO PERSONAL REFERENCES. YOUR REFERENCES SHOULD NOT LIVE IN YOUR HOME. AT LEAST ONE REFERENCE MUST NOT BE RELATED TO YOU. First and last name of first personal reference * References should not live in your home. At least one reference must not be related to you. Phone number of first personal reference * Relationship to you * SECOND PERSONAL REFERENCE: First and last name of second personal reference * Phone number of second personal reference * Relationship to you * Is there anything else you would like to share? 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 Courtesy Listing 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) * Signature/initials of second applicant (if applicable) BARK reserves the right to approve or deny any application for any reason and the right not to disclose the reason.
