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ADOPTION APPLICATION
IN WHICH DOG ARE YOU INTERESTED?
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Your Contact Information
First Name:
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Last Name:
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Driver's License Number:
Your Date of Birth
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Co-Applicant First Name
Co-Applicant Last Name
Co-Applicant Driver's License Number:
Co-Applicant Date of Birth
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Street Address:
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City:
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State:
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Zip:
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Email Address:
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Home Phone:
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Cell Phone:
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Preferred Contact Method:
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Home Phone
Cell Phone
Email
Text Message
Occupation:
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Employer:
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🛈
Employer's Phone Number:
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Where did you hear about us?
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Are you working with any other rescue? If so, who?
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When will you be ready to adopt?
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Are you willing to travel to Orange County to meet a dog?
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Yes
No
Undetermined
About Your New Dog
Have you read and understand the particulars regarding the specific pup you listed above? Do you acknowledge that you can meet the needs of this dog?
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Yes
No
What breed have you been considering?
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Do you prefer a:
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Male
Female
Either is okay
What personality traits do you wish your dog to have?
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How many hours per day will the dog be left alone?
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Where will your dog be when you are NOT at home?
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Where will your dog be when you ARE at home?
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Where will your dog sleep at night?
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When you are away
(traveling, etc.)
where will your dog stay?
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Does everyone in your home want this dog?
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Yes
No
Who will be responsible for the care of this dog?
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Do you
(or anyone in your household)
have any health conditions, physical limitations, or other special needs that we should consider in finding the right dog for you? For instance, the use of a walker, cane or wheelchair, etc. Please explain.
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Are you willing to adopt a special needs dog? If so, please explain.
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Your Home
Do you live in a:
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House
Apartment
Condo
Townhome
Mobile Home
Other
Do you own or rent your home?
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Own
Rent
Has your landlord approved having a dog in your home?
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Yes
No
Not applicable
Please provide contact information for your landlord.
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Please describe your yard
(grass, hardscape, fencing, pool, etc.)
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Do you have a pool or water feature in your yard? Please note: We do not adopt pups to applicants who have an unfenced pool or water feature. Do not apply if you have an unfenced pool or water feature. If you plan to fence your pool or water feature please do so BEFORE applying.
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Yes
No
Is your pool or water feature enclosed behind a safety fence so that your dog will not have access?
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Yes
No
I do not have a pool or water feature
Is your home more than one story?
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Yes
No
Does your home have stairs?
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Yes
No
Are the stairs covered in carpet?
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Yes
No
Do you have a dog door?
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Yes
No
How many people live in your home?
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1
2
3
4
5
More than 5
Please list the ages of
everyone
living in your home, including you and your co-applicant.
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If children
visit
your home, please list their ages and how often they
visit
.
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Animals Currently Living In Your Home
DOGS currently living in your home. Please tell us their name, breed, sex, age, spayed/neutered.
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Do you have CATS or OTHER PETS besides dogs living in your home?
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Yes
No
You have indicated that you have cats for other pets besides dogs living in your home. Please tell us their name, breed, sex, age, spayed/neutered (if applicable).
What brand and type
(kibble, raw, etc)
of food do you feed your dog?
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If your animals are NOT CURRENT on vaccinations, please explain.
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If there are any other animals in your home, please explain.
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More About You
Have you ever had a dog before?
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Yes
No
What breed/s have you owned before?
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Bichons and Bichon mixes require regular grooming for hair, ears, eyes and nail care. Are you prepared to provide these services?
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Yes
No
Do you use a monthly chemical flea, tick or heartworm product?
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Yes
No
Are you willing to accept responsibility for providing your dog with regular veterinary and dental care?
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Yes
No
Are you familiar with training a dog on basic commands such as sit, stay, off, etc.?
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Yes
No
Please explain your experience dealing with behavioral issues.
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If you have ever had to give up an animal, please explain the circumstances.
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Many Bichon's live for 15 years or more. Are you prepared to care for this dog for its lifetime?
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Yes
No
References
Veterinarian's Name:
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Vet Hospital Name:
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Vet Full Address:
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Vet Phone:
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Who will care for the dog if you are unable?
Future Caregiver's Name:
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Future Caregiver's Address:
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Future Caregiver's Phone:
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Future Caregiver's Email:
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Personal Reference's Name:
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Personal Reference's Address:
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Personal Reference's Phone:
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Relationship:
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Other Information:
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We greatly appreciate your interest in working with Bichon Rescue of Orange County to find your perfect pup. We often look for volunteers to assist us in the areas listed below. If any of these opportunities interest you, we'd love to have you join our volunteer teams.
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Administration
Data Entry
Events
Fundraising
Home Safety Evaluations
Leadership
Shelter Watch
Social Media
Telephone Assistance (answering, calling, etc.)
Transportation
Writing Assistance (replies, bios, grants, etc.)
None
If you would like to become a BROC foster, please fill out a foster application using the link below. Thank you.
Foster Application
We occasionally send out a newsletter with upcoming adoption events, adoptable pups, helpful tips, volunteer opportunities and more. Would you like to subscribe to our newsletter?
Yes, please subscribe me to the newsletter.
Sign Here
Type Your Name:
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Sign Here:
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Date Signed:
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Bichon Rescue of Orange County Adoption/Foster Application 2019