First Name*

Last Name*

Email*

Please make sure that you are able to answer "yes" to all of the following questions BEFORE submitting an adoption application.

If you are unable to answer yes to all of the following questions, your application will not be processed.

Do you and your household meet ALL listed adoption requirements for the dog you are applying for?*

If approved, are you prepared to move forward with an adoption within the next 7 days? *Please note we are unable to hold dogs.*

Application For:
Choose an animal: Charles (Charlie) Dani Downstream Furby Hannah Leo Ranger Ruby Skip Tony

Please list the name(s) of any additional dog(s) you are interested in adopting:

Street Address*

City*

State*

Zip Code*

Cell Phone Number*

Home Phone Number (Optional)

Are you 21 years of age or older?*

What is your occupation?*

Is your ENTIRE household on board for adoption? *

Please list the name AND age of EVERYONE currently living in your household (please include yourself):*

Have you, or anyone listed as living in the household ever been investigated for crimes involving an animal, including abuse and neglect? *

Does anyone listed as living in the household smoke inside the home?*

Does anyone in your family have allergies to dogs? *

What type of housing do you live in?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent the place you live? *
Choose one: Rent Own

If you rent, does your landlord allow pets? *

Have you received permission from your landlord? *

Landlord’s Name

Landlord’s Phone Number

Do you have a fenced in yard? *

Type of Fence
Choose one: Privacy Wood Metal Chain Link Invisible

Height of Fence

Yard Size:*

If you do not have a fenced in yard, how do you plan to keep the dog safe when outside for exercise and bathroom breaks?

How much time will the dog spend alone during the day?*

Where will the dog be kept when alone?*

Where will the dog sleep at night? *

Will the dog spend any time in the garage?*

Will your dog wear identification? *

Are you willing and able to exercise the dog on a regular basis? *

How do you plan to exercise your dog? *

How would you react if your dog were to destroy a household object or soil in the house?*

Will you provide your dog with professional obedience training and/or classes if needed?*

Do you believe in correction, positive reinforcement, or other (for training)? Please describe.*

Are you open to housebreaking your new dog? (*Accidents are expected from any dog during transition, regardless of housebreaking status)*

If you drive a truck, will you ever allow the dog to ride in the bed of the truck? *

What brand of food do you intend to feed this dog? *

What would you do with your dog if you ever had to move?*

Do you have an in-home daycare?*

Do you currently own any pets? *

If yes, please list each pet's name, breed, age, and where they are kept/housed (inside or outside):

Have all the pets listed above been spayed or neutered?

Are all of the pets listed above current on vaccinations (Rabies & Distemper at minimum)?

If ALL of your current pets are NOT spayed or neutered and current on vaccinations, why not?

Are your current dogs on monthly flea/tick and heartworm prevention? *

Have you ever had a dog become lost/go missing?*

If yes, what was the outcome?

Have you owned any pets in the past five years that are no longer in your possession? *

If yes, please list the breed, sex, age, and reason they are no longer with your family.

What routine medical treatments & preventives do you consider necessary for a dog? *

How much are you willing and able to spend annually on medical costs, food, grooming, and supplies for your dog?*

Are you prepared financially for annual and emergency care? *

A vet reference is required for all applicants. If you have never owned a companion animal, please list the information for the veterinarian you intend to use.

Name of Veterinarian:*

Name of Practice:*

Phone Number:*

Have you seen this veterinarian before? *

What name is your vet account under?

Please list three personal references that we could speak to (two of the three references must be non-family). Please provide full name, phone number, and relationship for each reference:*

Under what circumstances would you surrender your dog? Have you ever needed to surrender a pet in the past? If so, explain. (*We require all dogs to come back to SFCR if you cannot keep in the future. We expect our adopters to make lifelong commitments when pursuing an adoption)*

How did you hear about us?*

I understand that submitting this application to Sioux Falls Canine Rescue is not a guarantee of acceptance, and that approval is contingent on many factors including an in-person or virtual home visit completed by a representative of Sioux Falls Canine Rescue. By signing this application, I certify that all the information I have provided is true and correct. I give permission to Sioux Falls Canine Rescue to check my veterinarian and landlord references.

E-Signature:*