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hereby have in
Home Address *
Single Line Text
City *
State / Province / Region *
Postal Code *
Email *
Phone Number *
If you have a specific dog or dogs in mind, please provide their name(s) or description(s): *
Please describe what characteristics you are hoping for in a dog (e.g. gender, age, energy level, personality, and socialization) *
What type of home do you live in (house, apartment, et cetera)? Do you own or rent your home? How long have you been at this address? *
If renting, please list the landlord or property manager name and phone number:
Would you be willing to allow us to visit your home by appointment? *
What humans currently live in the home? Please provide the ages of all household members: *
Does any member of the household have allergies? If so, to what? *
What animals currently live in your home? (Please include species, breed, and age): *
Are you financially able and willing to provide annual checkups, vaccinations, and any medical care necessary? *
Do you have a regular veterinarian? If so, please provide clinic name: *
Who will be responsible for the daily care of this pet? *
Where will the dog stay during the day? *
Where will the dog sleep at night? *
If you do not have a fenced yard, how will you safely contain your dog while outside?
How do you plan to exercise your dog and how often? *
If yes, who will care for the dog?
If a disciplinary or behavior problem arises, what steps will you take to work on it? *
What will you do if your new dog doesn’t get along with your present pets? *
Have you or anyone in your household ever been (i) charged with, or convicted of, animal cruelty, neglect, or abandonment, (ii) the subject of a civil proceeding to terminate your ownership rights of a dog, cat, or other companion animal, (iii) ever surrendered an animal to, or had an animal seized by an animal control officer? *
Please indicate acknowledgement of the following statements: The animal(s) were previously housed at a regulated research institution and cared for by trained, dedicated, and loving veterinary and animal care professionals under strict ethical and welfare oversight. Their release is part of a responsible retirement and rehoming program. *
Do you agree not to publish, post, or communicate any false, misleading, defamatory, or materially disparaging statements concerning WACRRA, the originating research institution, or their personnel in connection with the adopted animal(s)? *
How did you hear about WACRRA? *
Provide any additional details.
Please include the name, phone number, email address and relationship of at least two people who can attest to your suitability as a pet owner. *