Dog Adoption Application

Thank you for your interest in adopting a dog from the Baldwin County Humane Society (BARC!) no-kill adoption agency. Prospective pet parents need to complete this application. When you click on the “submit” button, Deneen Balistere, our Dog Adoption Coordinator, will instantly get it.

EVERY APPLICATION RECEIVES PRIORITY PROCESSING!

APPLICANT INFORMATION

I am at least 19 years old
 Yes No

Name of dog you're interested in

First Name

Last Name

Applicant Street Address

Applicant City

Applicant State

Applicant Zip

Applicant Cell Phone

Applicant Home Phone

Applicant Email

Applicant Employer Name

Applicant Employer Address

Applicant Employer Phone Number

Applicant Occupation

Co-Applicant First and Last Name

Co-Applicant Relationship to Applicant

Co-Applicant Email

Co-Applicant Cell Phone

Co-Applicant Employer Name

Co-Applicant Employer Address

Co-Applicant Employer Phone Number

Co-Applicant Occupation

DOG INFORMATION

Have you contacted another rescue group? If yes, please list the group name, contact person and phone number.

Describe the dog you are looking for

Why do you want this dog?

When are you looking to adopt?
 Right Away In a few weeks Over a month

How many dogs and cats have you owned before?

Where did they come from?
 Breeder Shelter Rescue

What happened to them?

What Heartworm preventative are your current dogs taking?

HOME AND FAMILY INFORMATION

How long at current address?

Do you agree to a home visit pre-adoption and post-adoption?
 Yes No

Live in a
 House Mobile Home Apartment

Rent or own?
 Rent Own

If renting, does lease permit dogs?
 Yes No

Landlord name and phone number

Size of yard

Is yard completely fenced in? If yes, what material and height?

Crate available?
 Yes No

Kennel available?
 Yes No

Are you willing to buy a crate or kennel?
 Yes No

Number of people in the house

Number of children and ages

Anyone allergic to dogs?
 Yes No

How do the children interact with dogs?

Other pets in the house
 Dogs Cats Birds Other

If other dogs in house, provide breed, sex, age and describe temperament

EXPECTED ROUTINE

How much time will be spent with the dog daily?

How many hours will the dog be left alone daily?

Where will the dog be when you work?

Where will the dog sleep?

When will the dog be outside?

Will the dog be tied out?
 Yes No

How often will the dog be walked?

Where will the dog be walked and by whom?

How often will the dog be played with and by whom?

Will the dog be crated when left alone?
 Yes No

Where will the dog be when you are away overnight?

Will you take the dog to obedience training?
 Yes No

Please list any unusual circumstances the dog will need to adapt to

Other comments regarding daily routine

Where did you see this dog?

If not interested in a specific dog, please tell us what you are looking for

Size dog looking for
 Small Medium Large

Gender of dog looking for
 Male Female

Length of hair on dog you're looking for
 Short Medium Long

Breed looking for...is mix ok?

List other qualties that are important to you

REFERENCES

Current Vet Information -- Name, Address, City, ST & Zip

Current Vet Phone Number

Personal Reference #1 -- Name and Relationship

Personal Reference #1 Phone Number

Personal Reference #2 -- Name and Relationship

Personal Reference #2 Phone Number

Groomer (if applicable)

Groomer Phone Number

APPLICANT DISCLOSURE

Do you feel financially able to care for a dog for its lifetime?
 Yes No

Do you feel physically able to care for a dog for its lifetime?
 Yes No

Please tell us anything else you would like us to know about you, your home, your family or application


I give my consent to the Baldwin County Humane Society (BARC!) to contact the listed references. Any information obtained by BARC! will remain confidential.
 Yes No