Adoption Application

Placing a pet in a proper home is critical to our operation. Please fill out the form below to your best ability. By doing so, Canine Estates can match you with a likely candidate for adoption.
Name of Dog desired:

Applicant's Name: Co-Applicant's name:
Email Address:
Address line 1
Address line 2 (optional)


State / Province

Postal / Zip Code
Daytime Phone:
Area code + Number
Evening Number:
Area code + Number
Applicant's Age: Co-Applicant's Age:
Why would you like a dog at this time?
Why do you prefer this breed?
Ideal weight of dog:
Would you consider a special needs dog? Would you consider a dog that is not housebroken?
What are your thouhts on the use of crate training for your dog?
Applicant's Occupation: Co-Applicant's Occupation:
Applicant's and Co-Applicant's place of employment and telephone number:
Please specify what type of home you live in: Do you rent or own?
If you rent, please provide the name and telephone number of your landlord:
How long have you lived at your current address? How long at your previous address?
Please list all of the people currently living at this address, their relationship to the applicants, and their ages:
Do you have a pool or hot tub? If yes, is it fenced or covered?
Home visits are required by rescue. Are you ok with this? Days and times you're available:
If you work, will there be a person at home to watch your pet? Do you have a completely fenced area on your property?
If no, please tell us how you'll address the dog's exercise and bathroom needs, etc.
How many hours each weekday will your dog be alone? How many hours each weekends will your dog be alone?
Where will your dog be kept during the day (Loose indoors, crate, basement, laundry room, kitchen, other confined room, fenced yard, chained outside, dog run, outside kennel run, on lead attached outside, loose outdoors, garage, dog house, etc.)? Please be specific:
Where will the dog sleep at night? Again, be specific:
Who will be responsible for feeding the dog? Who will be responsible for housebreaking the dog?
How much experience does this person have in housebreaking and training a dog? Explain. How would you handle housetraining? Explain:
Who will care for the dog in the event you are ill, on vacation or otherwise incapacitated? Have you, as an ADULT, owned a dog before?
If the dog is no longer with you, please provide a brief explanation of where it is now.
Have you ever had an animal die at an early age? If yes, please explain:
Have you ever given an animal to another person, rescue or shelter? If yes, please explain:
Please list any pets who currently live in your house. Include their name, breed, sex, age, years owned and whether or not they are spayed or neutered.
Are these pets up to date on shots, heartworm preventative, veternary care, etc. If not, please specify which ones and why not.
Vet Reference: We require that you provide the name of your current vet, or id you have no animals at this time, the name of a vet you have used in the recent past. We will call this vet to check on your previous care of animals.
Name of Vet's office: Vet's Phone Number:
Area code + Number
Vet's Full Name:
First Name

Last Name
Approx date of last visit:
Reason for last visit?
What name are vet records listed under?
Groomer reference: If you have a groomer you have used before, please list the name and phone number here:
Personal Reference 1 - Name and phone number: Personal Reference 2 - Name and phone number:
Personal Reference 3 - Name and phone number: Personal Reference 4 - Name and phone number:
How did you hear about us?