Application
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For the time being, please email me for the application - deb@thedognextdoor.com
Providing a home visit can be arranged, approval usually takes three days to a week.
Providing a home visit can be arranged, approval usually takes three days to a week.
DOG ADOPTION APPLICATION
Instructions and General Information:
This application MUST be fully completed by anyone interested in adopting a pet from thedognextdoor.com. Failure to do so will result
in an automatic rejection. Thedognextdoor makes no apologies for the length and detail of its application and contract. The time it
takes you to complete the application is nothing compared to the 10, 12, 14 years or more you will have your companion animal – and
we want to feel comfortable that you will have the Dog for the life of the Dog. The dog you are adopting is a wonderful living creature
who has been given a second chance at life by thedognextdoor and Deborah Wood. All our dogs were scheduled to die or were
relinquished to us in lieu of sending the dog to a kill shelter. Thedognextdoor.com reserves the right to refuse an adoption for
ANYONE for ANY reason. All applicants must be a minimum of 21 years old, have a verifiable source of income, be a legal resident of
the United States and provide a valid ID. Applicants AND THEIR SPOUSE OR OTHER ADULT LIVING IN THE SAME HOUSEHOLD can
have NO publicly available criminal record involving violence or acts of aggression, and none for the past ten years involving drugs,
alcohol or moral turpitude– this is for the safety of the animal, We do not want to deny any person willing to care for a dog for the
duration of its life a pet, however, our only responsibility is for the health, welfare, safety and happiness of the animals in our care.
Each and every case will be evaluated on an individual basis.
If you fraudulently represent ANYTHING in this application, you will be denied. However, I believe people can change and bad things
happen to good people, so if any of these apply to you and you want your case evaluated on an individual basis despite the “issue”
please check here: • extenuating circumstance evaluation. If I decide to give you a chance and allow you to adopt a dognextdoor dog,
your signature on this application and the contract give me the full right to reclaim the dog, no questions asked, if you commit any
additional crime whatsoever (misdemeanor or felony) other than a minor traffic violation during the life of the dog.
All dognextdoor dogs are inside dogs, from 10 lbs to 110 lbs to 150 lbs. They may only be outside while supervised. This is to protect
your dog from being stolen, shot, poisoned, or from escaping your yard. This is to keep your dog part of your family, to keep your dog
happy. A happy dog is a good dog. A dognextdoor dog may never be tethered. Not for a minute while you run inside to catch the
phone, not for two minutes while you put the lawnmower away and certainly not while he is on a deck or porch nor for hours at a time.
NO TETHERING. A dog can break his neck or choke to death in mere seconds on a tether
The dognextdoor reserves the complete right to reclaim any dog who is not kept on heartgard or a similar heartworm preventive, or
who tests positive for heartworms at ANY TIME IN THE LIFE OF THE DOG. We reserve the right to reclaim any dog who is more than
thirty (30) days late receiving his/her annual vaccinations, who does not receive IMMEDIATE vet care for any injury or does not receive
vet care within 24 hours of showing signs of ANY illness, who is allowed off-leash outside a SECURELY FENCED ENCLOSURE, who
is not fed a premium food on the list of foods provided to you with your contract, who is not exercised regularly, who suffers a
significant weight loss over any three month period for ANY reason EXCEPT aging, who is crated more than 8 hours a day or crated for
punishment, who is “spanked” or struck for ANY REASON, who is not placed into an approved basic training program within thirty days
of adoption (Petsmart has an excellent approved program for $100 for eight weeks of training) or for any neglect or abuse and the
definition of abuse is at the complete discretion of thedognextdoor, Deborah Wood or Caryll Rinehart – and can include anything from
improper feeding, care, lack of time spent with the dog, failure to keep the dog’s bedding and play area clean, failure to keep the dog
clean, lack of exercise or harming the dog in ANY way or for any reason we deem justifiable.
Information you are required to update regularly (i.e., changes in living arrangements (divorce, marriage, adoption of children, etc.,
change of address, change of veterinarian, etc.)) may be updated by email, letter or telephone. We will confirm receipt of any change.
This requirement is not designed to interfere with your relationship with your dog or to invade your privacy. It is to ensure that this dog
has a FOREVER home. All dognextdoor dogs must be returned to thedognextdoor if you relinquish the pet for ANY REASON
WHATSOEVER. It may NEVER BE TURNED OVER TO A LOCAL “POUND” OR ANIMAL SHELTER WHERE IT WILL MOST LIKELY DIE.
If a dog next door dog is ever turned over to animal control, we WILL file a lawsuit against you. If you ever give a dog next door dog to
ANYONE other than returning the dog to us, you will be SUED. Even if the dog bites someone, (which is very very very unlikely unless
the bite is deserved, i.e., the dog is injured, in pain, being tormented or teased or being harmed, beaten, chained or tethered, etc. If a
dognextdoor dog has EVER bitten ANYONE and we are aware of it, you will have been informed verbally and it will be in the FULL
DISCLOSURE section of your contract.
PERSONAL INFORMATION
Name: Age:
Home Address:
City: County: State: Zip
Home Phone: Work Phone: Cell Phone:
Employer Name and Address:
If self-employed, name of d/b/a, LLC, etc. and type of business
Have you ever been charged with or convicted of a crime involving violence or aggression? Yes • No •
If yes, when, where and what were the circumstances?
Have you been charged with or convicted of a crime involving drugs or alcohol within the past ten years?
Yes • No •
If yes, when, where and what were the circumstances?
Has ANYONE living in your home ever been charged with or convicted of a crime within the past ten years?
Yes • No •
List everyone living in your home and all the names they have used in the past:
Spouse/Partner Adult Child in Same Household Information (Required if living at the same residence with the pet)
Name: Age:
Cell Phone Work Phone:
Employer Name and Address:
If self-employed, name of d/b/a, LLC, etc. and type of business
Have you ever been charged with or convicted of a crime involving violence or aggression? Yes • No •
If yes, when, where and what were the circumstances?
Have you been charged with or convicted of a crime involving drugs or alcohol within the past five years?
Yes • No •
If yes, when, where and what were the circumstances?
Will the animal live at the address above? Yes • No •
If “No”, please give address where the animal will live and why:
HOME INFORMATION
Type of Home (mobile, ranch, apartment, two-story, rv) _______________________________________
Do you Own Home • Rent Home •
Landlord’s Name:_________________________________ Phone Number: ______________________
Does your landlord require a pet deposit? Yes • No •
If Yes, how much is the Pet Deposit $_______________________
** Proof of residence must be provided before adoption and a copy of your lease addressing pets in your apartment must be provided.
If you rent or lease, your landlord may be contacted, however, you WILL be notified BEFORE your landlord is called.**
Do you have a securely fenced yard (no gaps in or under, no gaping gate posts)? Yes • No •
Type of fence (privacy, chain link, hog wire, chicken wire, dog run, dog kennel?)
________________________________________________ Height __________________
If your yard is not fenced, are you willing to provide a fence or fenced in area for the
dog to run and play? Yes • No •
What is the date that you can have a secure fenced installed? _________________________
Yard size is: Small • Medium • Large • Acreage • No Yard •
Or are you an avid walker or jogger? Yes • No •
Do you have a pool? Yes • No •
If you answered yes:
Is the pool securely fenced? Yes • No •
What type of steps do you have in the pool (i.e. removable or fixed ladder, broad steps)
Do you have a depth alarm on the pool or video cameras monitored from within the home?
Yes • No •
How long have you been at this residence?
If you have moved in the past seven years what are your previous addresses:
How many adults live in the home? Children? Ages of Children
Are there children who will visit regularly (visitation rights, grandchildren, nieces, nephews, etc.)? __ ____ If yes, provide their ages:
____________________
Does any member of the household (or children who will visit regularly – as above) have known allergies? Yes • No • If your
answer is no, SKIP to the next question.
If yes, are they adequately controlled medically?
What is the longest period this person has been around a pet?
What was the ultimate outcome?
Have you discussed pet ownership with your family physician?
His/her recommendation?
ANIMAL OWNERSHIP HISTORY (this refers to dogs YOU AND YOUR SPOUSE have had as ADULTS – (not living with your parents)
(including dogs you were guardians for PRIOR to your marriage but again, as ADULTS) you may include childhood dogs if this is
YOUR first dog – and you want to show us your experience with dogs)
How many pets have you had in the past and what were they (cat, dog, bird, etc.)?
______________________________________________________________________
If any, please describe what happened to each of them. If they were rehomed, give the name, address and phone number of the
person who took the dog: ______ ________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Please list all pets and species/breeds of animals currently living in the home. If canine, please indicate whether any are “alpha” or
aggressive?
Are your current (or most recent) cats and dogs spayed or neutered? Some • All • None •
If no, why not?
Are the animals (or most recent animals) current on their vaccinations? Yes • No •
Name, Phone and address(es) of your Veterinarian(s) ______________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
If you do not have a veterinarian, please give the name address and phone number of the vet you plan to use. You must keep
thedognextdoor up to date on your vet should you change vets. We do confirm that your annual vet visits are maintained.
Sign here agreeing to keep us apprised of your vet’s name and giving us permission to contact your vet every year for the life of the dog:
Signature: ______________________________________________________________
Have you ever (as an adult) had a dog for a short time (less than one year) and it didn’t work out? Yes • No •
If yes, please explain the circumstances and what happened to it _________________________
______________________________________________________________________________
If you have ever given a dog or cat away for any reason, please give the name, address and phone number of the person you gave the
pet to and why .
Have any of your pets (or pets in the past) lived primarily outdoors? Yes • No •
If yes, please describe pet and its living conditions______________________________________
Have you ever had a pet die of anything other than natural causes? Yes • No •
Please give the details.
Have you ever had a pet die under the age of 8? Yes • No •
Please give the details.
Have any of YOUR pets (not strays) been picked up by or taken to animal control? Yes • No • If yes, why?
_______________________________________________________________
Have you ever adopted a pet and returned it? Yes • No •
Where did you adopt and return it?
If yes, what was the reason?
Have you ever been denied adoption of a pet? Yes • No • If yes, by whom?
When? What was the reason you were given?
**Thedognextdoor.com WILL check AND VERIFY all animal control records in the area in which you reside AND where you have
resided for the past seven years – if a metropolitan area, we will check a five – seven county radius**
CURRENT AND PAST DOG OWNERS
Is your current (or most recent) dog on heartworm prevention? Yes • No •
If yes, how often do (did) you give the heartworm medication?_____ ____________________________
What brand do (did) you use?_____ _____________________________________________________
Is your current dog (or most recent) on flea and tick prevention? Yes • No •
If yes, how often do (did) you give the preventative?_______ _______________________________
What brand do (did) you use?_______ ______________________________________________
PLANS FOR THIS ANIMAL – please respond to this entire section
With this pet, how many animals will live in the household?_______________________________
Why do you want this animal whether your first or an additional pet? (please check all that apply)
• Companion
• Pet for Child
• Pet for Family
• Gift for Adult
• Gift for Child
• Guard Dog
• Companion for Another Pet
• Breeding
• Not Sure
• Other______________________
Where will your new dog stay when alone during the day?_______________________________
____________________________________________________________________
Where will your new dog sleep at night? _______ ____________________________________
REMEMBER no dognextdoor dog can be off leash FOR ANY REASON WHATSOEVER unless he/she is in a SECURELY FENCED
ENCLOSURE.
What percentage will the dog spend inside %_____ outside%______
Have you ever tethered a dog outside?
Tell me the circumstances, why, for how long, were you or someone else with the dog, etc.
What hours will the dog be alone each day regardless of the time of day.? ___________________________________
If you will be out of town, who will care for this dog?_______________________ If this is an individual, have you discussed this
possibility with them yet? ___ ________ You may also consult with the dognextdoor if you adopt in the vicinity of our facility about
watching your pet (for a reasonable fee) while you are out of town.
How do you plan to exercise this dog? _________________________________________
What do you plan to feed your new dog?
What do you consider “healthy” treats for a dog?
Who will be responsible for the daily care and training of your new dog?____ __________
How do you plan to train your new dog?:
• Training Classes • Spanking • Gentle Leaders • Choke or Pinch Collars • Clicker Training
Other__________________________________________________________
It may be mandatory that you get a minimum of basic obedience training for your dog. One of the most important things you will learn
in basic obedience is HOW TO TRAIN YOUR DOG with gentle, loving, positive reinforcement. You will learn basic commands and
training that you can rely on to teach your dog many more behaviors that you want and that are appropriate for your home and lifestyle –
including “tricks” which are fun and a great bonding tool. You will have typically have between thirty and ninety days from the date of
adoption to get your dog into training classes and you MUST inform thedognextdoor of the name of the trainer or program, the address
and phone number and the date training begins and ends. We will require a copy of the certificate of completion of the training. If
training is mandatory for the dog you choose, failure to do so WILL RESULT IN THE DOG BEING RECLAIMED IMMEDIATELY.
What circumstances, do you think, justify giving a dog up? Check all that apply
• Moving
• New baby
• Not getting along with other pets
• Marriage/Divorce
• Getting out of fence
• Behavioral problems (potty training issues, separation anxiety, etc)
• Dog gets too big
• Children lost interest
• Too time consuming
• Shedding
• Allergies
• Aggressive behavior
• Nothing justifies giving up a pet
• Other (please explain)_____________________________________________________________
If you move in the next five years (to a new home in state OR out of state) what are your plans for this dog?
______________________________________________________________
______________________________________________________________________
If your dog later develops a medical problem that becomes expensive what would you do?
• Find another home for him
• Pay whatever it takes
• Have him put to sleep
• Give him to a rescue group or shelter
• Contact thedognextdoor and ask them if they have the resources or a vet that can help or help finding resources to help me pay for
the treatment **
• Other (please explain) _____________________________________________________
_________________________________________________________________________
** (also note – any dognextdoor dog MUST be returned to thedognextdoor (or its legal designee) if you EVER give the dog up for any
reason, including health reasons (except (obviously) in the case of a critical illness where your vet recommends humane euthanasia
– this is a personal decision) – if, however, the decision to euthanize is strictly financial, if there is TIME (for example a diagnosis of
operable cancer which will give the dog another two or three years but the surgery is $2,000 that you just do not have) please contact
us and see if we can help you – WE CANNOT ALWAYS DO SO – OUR MONEY IS EXTREMELY LIMITED – I PAY FOR ALL VET BILLS
FROM MY SALARY, but I am always willing to try to help you and to help you find other resources – we also have a vet who might work
with us for a much lower rate than your vet is willing to give you – so unless the decision is an emergency (the dog was hit by a car and
will die without a $4,000 operation – there may not be time for us to help you find resources and the decision to euthanize may be the
best and only option. However, if your dog is hit by a car, it means you allowed the dog off leash and that WILL result in a lawsuit by
thedognextdoor for negligence regardless of whether the dog lives or dies. Additionally, your pet can never be adopted to another
home or relative without PRIOR approval. It must be returned to us if you have to give the pet up for ANY reason including health
related issues.
Are you prepared to provide a safe and permanent home for this dog for the next 10 to15 years (average lifespan of a dog which may
be less and may be more) – this includes taking the dog into consideration when moving, marrying, divorcing, having children, aging
issues, IF THE DOG IS FOR AN OLDER CHILD OR TEENAGER, HAVE YOU CONSIDERED WHAT WILL HAPPEN TO THE DOG
WHEN THE CHILD GROWS UP AND LEAVES FOR COLLEGE OR MOVES OUT OF YOUR HOME – have you fully considered how you
will take care of and provide for this dog as you confront inevitable changes in your life circumstances? Marriage, divorce, new home
or apartment, aging, etc. Dogs are NOT DISPOSABLE, require a long-term commitment, can be VERY expensive and may be with you
a very long time?
Yes • No • Have not thought about it •
MEDICAL, GROOMING AND PHYSICAL CARE INFORMATION – This section is used to make you aware of the commitment you are
making financially and with your time and energy – owning a dog is an expensive undertaking and thedognextdoor.com REQUIRES
that you provide the best care possible for its adoptive dogs this does not mean the most expensive vet, the most expensive food or
that you clothe it for seasonal weather changes, it simply means that you meet the dog’s physical and emotional needs, that you get
the dog vetted annually, that you maintain ALL preventive measures – this is KEY to your dog’s longevity! The dog’s emotional health is
also critical to its longevity. You should always interact with the dog as a family member. Mental and emotional health is as important
to your pet as it is to you, particularly if you have small children. This section will also help us, help you. I will personally email you
information that might help you provide care for your new “best friend” – this is particularly important for first time dog guardians – if you
choose not to receive emails offering tips and advice, simply respond to my first email asking to be removed from the mailing list –
these are occasional emails that are short without troubling pop-ups, they are hand prepared by me – I am also available 24/7 to
answer any questions you have about your dogs issues, health, or behavior – this section lets me know if there are any areas about
your new dog that might be helpful to you – this is not a test – nor will these answers be considered in allowing you to adopt a dog
and there are no “wrong” answers .
How often should a dog be bathed?
How often should a dog see the vet?
In addition to brushing your dog’s teeth EVERY DAY, you dog should have regular dental exams and regular cleaning by a vet. How
often should you have your dog’s teeth professionally cleaned?
How much will it cost to have your dog’s teeth professionally cleaned
How do you plan to groom your dog? • Groom him myself • Pay a professional groomer
• let the kids bathe him/her
If you plan to pay a professional groomer, how much do you think it will cost per visit? _____________
How long would your dog have to whine and scratch his ears before you took him to vet to have them checked?
How often should you brush your dog? • Daily • Weekly • Monthly Other: _____________
Which of these do you think are good “treats” for your dog?
Carrots ____ Rawhide chew _____
Dog biscuits _____ Raisins ______
Grapes ______ Cooked Chicken bones _____
Piece of deboned chicken _____ Bacon strip _____
Raw rib bone ______ Hot dog _________
Cantaloupe chunks ____ Piece of cheese _____
How often should you refill your dog’s bowl with fresh water?
How much do you think a visit to the emergency vet will cost you?
How much do you think your annual vet visit will cost (just for his shots, checkup, heartworm test, fecal exam, the basics)?
How much do you think the upkeep (vet visits, heartworm preventive, flea preventive, feeding, vitamins, toothpaste/brush,
supplements, boarding, toys, leashes, collars, training, etc.) will cost each year you are a guardian to your pet?
EUTHANASIA
Have you ever or do you know someone who has had a pet euthanized? Yes_____ No ______
Did you agree with them and why or why not?
If your dog were terminally ill and you knew without a doubt that your dog was suffering, would you consider humane euthanasia?
Yes_____ No ______ I don’t know ______
If you answered no or I don’t know, why did you answer that way?
If your pet is euthanized for any reason will you have the courage and respect for what he/she has given to you to be with your pet, not
him die alone without you and give him the love and dignity to pass on with you or some other family member holding him?
Yes_____ No ______ I don’t know ______
If you answered no, please consider contacting thedognextdoor when that time comes – again, if there is time to make that choice - I
will be willing to come be with your dog while he/she passes. This is certainly not mandatory – death is a personal decision – but I
have loved, however briefly, the dog you are adopting and I am always willing to be there for him/her and for you when this difficult
times comes – if that is your wish.
By my signature on the next line, I agree to allow a thedognextdoor.com agent to inspect my home and/or check on the condition of the
dog I adopt upon reasonable appointment for the life of the dog. _____________________________________
thedognextdoor.com wants you to have a life-long, loving relationship with your new pet but we understand that bad things sometimes
happen to people and families. You should not lose your beloved friend or have to give your companion up just because you run into
temporary hard times. If you or your spouse loses a job, and/or are working or looking for work, or if one of you becomes ill, or has an
ill child, or any number of unfortunate incidents befall your family, we will work with guardians to keep the animal in the home as long
as a safe and loving environment can be provided there. This includes helping you find funds for medical emergencies, assisting you
with food, routine vaccinations, heartworm and flea preventive in a financial emergency. We want to give you every opportunity to keep
your “family” intact. Sometimes, in difficult times, our pets are our strength and it is our desire to see to it that your pet remains with
you during troubled times – so let us try to help you. However, if you find it absolutely necessary to relinquish the animal, you agree to
return the animal to thedognextdoor.com and bring all paperwork and identification tags obtained, as well as any paperwork or
veterinary records obtained after the adoption.
Please initial that you understand that thedognextdoor and/or Deborah Wood will try to assist you in keeping your dog during times of
financial hardship, this is not a “charity” it is simply the “right thing to do” – if you think that “charity” might prevent you from contacting
us for assistance, you are welcome to sign and agreement to repay us – but the bottom line is you AGREE TO CONTACT US rather
than see your dog go without vital medical care, vaccinations, food, or preventive medication and that this is “temporary” assistance in
the case of a valid emergency INITIAL ONE: I understand and agree _________; I understand and I do not
agree __________; I do not understand this clause ____________
I agree to read the adoption contract, and upon execution to abide by its terms, prior to the adoption being approved.
Yes • No •
With my signature below I hereby attest that all of the information given in this application is true and accurate to the best of my
knowledge. By my signature, I understand and agree, that if thedognextdoor.com learns at any time that the information provided is
false, I will be in breach of the adoption contract I will be executing and thedognextdoor.com will remove the dog from my home without
any further notice. I further understand that, if a dog has been released to my care on a temporary basis pending approval of this
application and execution of the adoption contract, including the contractual 30-day “probationary” period, a trial visit, etc. the adoption
is NOT FINAL UNTIL and is subject to the answers on this application and the conditions of the contract and that the pet is placed with
me on a CONDITIONAL BASIS, pending approval based on verification of the information provided. The terms of the contract I enter
will be final and binding upon execution. During the first 90 days, I agree to contact thedognextdoor at least weekly and will report
honestly on the condition of the dog, his attitude, his eating, drinking, sleeping, urinary/bowel and play habits. This is to ensure that
the dog remains healthy and that the dog and the family are comfortable together and that the dog is adjusting to its new home and
will be well-cared for. After the expiration of ninety days the adoption is final but the dog is ALWAYS SUBJECT TO REMOVAL FROM MY
HOME IF I AM IN BREACH OF THIS APPLICATION OR THE CONTRACT. including but not limited to failing to keep the dog leashed
when not in a securely fenced enclosure, tethering the dog, OR that the dog shows signs of depression and that he/she is not
adjusting well to the new environment (lethargic, not eating, not interacting with the family, etc. or a veterinary diagnosis of anxiety or
depression), including neglect or abuse. IF THE DOG IS LOST OR RUNS AWAY I AGREE TO IMMEDIATELY NOTIFY THE MICROCHIP
COMPANY AND THEDOGNEXT DOOR and commit pursuant to the contract to expend the resources necessary to locate the dog. But
my first obligation is to ensure that this does not occur. I further agree to return the dog if I know that the dog is not adjusting well to
my home – it is imperative, and I understand, that the dog needs to be as happy with me as I am with the dog. I may return the dog at
any time for any reason but any refund I may be entitled to will only be valid during the first thirty (30) days. If I am entitled to any refund
or partial refund, it will be paid within thirty days of the surrender of the dog and all paperwork, tags, etc.
Signature Date ______
Print Name
Signature (Spouse/Companion) Date
Print Name:
References:
Please list below the names and phone numbers of four friends, co-workers or neighbors – NO RELATIVES. The references must
have known you and been in contact with you for AT LEAST the last five years AND MUST HAVE VISITED YOU IN YOUR CURRENT
HOME.
PLEASE PROVIDE FOUR - At least three (3) of these references will be contacted prior to
Name Address Phone Number Relationship (Coworker/Friend/Church)
Please provide the following information on two first tier relatives (mother, father, brother, sister, son, daughter) – use second tier
(aunt, uncle, cousin, grandparents) if there are no first tier relatives surviving you and you may also use an ex-spouse. These
references CANNOT BE LIVING WITH YOU AND they are for our use only. The may or may not be contacted.
.
RELATIONSHIP: _____________________________
___________________________________________________________________
Name
_________________________ ______________________ ___________ _______
Street Address City State Zip
______________________ _____________________ ______________________
Home Phone Work Phone Cell Phone
RELATIONSHIP: ______________________________
___________________________________________________________________
Name
_________________________ ______________________ ___________ _______
Street Address City State Zip
______________________ _____________________ ______________________
Home Phone Work Phone Cell Phone