Updated App .pdf

Dog Applying For: ___________________

Texas Star Rescue Adoption Application
Please fill this form out as completely and honestly as possible! No one knows what you are looking for in your next new family
member better than you do. In order for us to provide you with the best match possible, we need to know a few things about you.

Contact Information
Your Name: _______________________________________
Email: ____________________________________________
Address: __________________________________________

Cell Phone: ____________________________________
Alt Phone: ____________________________________
City, State & Zip: _______________________________

Veterinarian Information

Primary Veterinarian: ________________________________
Address: __________________________________________

Phone: _________________________________
City, State & Zip: _________________________

At Home
I ☐ Own ☐ Rent my home. (Please check one) May a rescue volunteer visit for a home-check? ☐ Yes ☐ No
Landlord Name (if applicable): _______________________
Phone Number (if applicable): ______________________
If yes, what kind of fence? ____________________________________
Do you have a fenced in yard? ☐ Yes ☐ No
Do you have any other pets? ☐ Yes ☐ No If yes, how many and what kind/breeds? ___________________________
______________________________________________________________________________________________________
Are they spayed/neutered? ☐ Yes ☐ No Do you involve your pet(s) in breeding activities? ☐ Yes ☐ No
Which of the following do your pets received on a regular basis?
☐ Rabies
☐ 7-Way/5-Way
☐ Bordatella (Kennel Cough)
☐ Heartworm Prevention
☐ Flea/Tick Prevention
☐ Other/Comments: ________________________________________________________________________________
Are any of your dogs outside-only? ☐ Yes  No Do you chain any of your dogs while outside?  Yes  No
How many hours a day is your dog left on a chain? _______________________________________________________
Do any of your dogs have aggression problems with new dogs? ☐ Yes ☐ No If yes, how are you planning to integrate
your new pet into your home? _________________________________________________________________________
____________________________ ______________________________________________________________________
Do you have children? ☐ Yes ☐ No What kind of temperament do they have? ______________________________
__________________________________________________________________________________________________

What You’re Looking For
Breed(s): _________________________________ Purebred only? ☐ Yes ☐ No
Preferred Age:_________________
Housebroken Only? ☐ Yes, I do not have time to housetrain a new dog. ☐ No, I do not mind continuing housetraining.
How many hours a day will the dog be left alone (e.g. while at work, running errands, etc.)? ☐ 0-4 hrs
☐ 8-12 hrs ☐ 12 hrs +
Personality traits you would most prefer:
☐ Playful
☐ Calm
☐ Barks
☐ Doesn’t bark loud/much

☐4-8 hrs

☐ High Energy
☐ Likes toys

☐ Low Energy
☐Excitable

☒ Affectionate
☐ Protective

☐ Doesn’t require/want much physical attention
☐ I’m flexible with different personality types

Comments about what you are looking for that was not covered in this application: ____________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

The adjustment period for a new pet could take up to TWO months or longer. Which of the following behaviors would
you NOT be willing to work through to make the adoption a success?
☐ Nipping
☐ Barking
☐ Separation Anxiety
☐ Chewing
☐ Jumping
☐ Crying
How many pets have you had to rehome in the last 12 months, and why (e.g. moved to a new town, couldn’t take dog to
new house, etc.)? _________________________________________________________________________________

I verify that the information I have provided above is correct and true to the best of my knowledge. I understand that a new dog could
be up to a 20 year commitment, and I am prepared to make such a commitment to this or any animal provided to me by Texas Star
Rescue. Texas Star Rescue has my permission to contact my veterinarian and/or my landlord and to perform a home visit.

_________________________________________________
Applicant Signature

________________________________
Date

OFFICE USE ONLY
Vet Reference Comments:_____________________________

Home Check Comments:___________________

Other Comments:____________________________________

Approved By/Date: _______________________