Name:
Street:
City/State/Zip:
Home Phone:
Work Phone:
Email:
Please indicate your age group: Under 18 18-25 26-45 46-65 Over 65 Click Arrow for Selection
How did you find out about Second Chance Dog Rescue & Referral, Inc?
How long would you like us to keep your application active? 1 Month 3 Months 6 Months 1 Year or More Please discard my application if you don't have a dog available immediately. Click Arrow for Selection
Would you like us to share your application with other rescue groups that may
have a dog suitable for you?Yes No
If you are outside of the Savannah, GA area, what arrangements would you make to transport a newly adopted dog to your home? **PLEASE NOTE - Out-of-town applicants will not be considered if this question is left blank!**

Please read the following statement and select response below:
I authorize my veterinarian and his/her staff to speak to a representative of Second Chance Dog Rescue & Referral, Inc. regarding the health care of my pets, both currently and previously owned. Additionally, I authorize said representative to contact any person whose name is listed on this document.
I agree I do not agree
Is there a specific dog listed on our website that you would like to adopt? Yes No
If Yes, please indicate which dog:
If no specific dog, what breed of dog are you interested in adopting?
What age dog would you prefer?
Which sex would you prefer? Male Female Doesn't Matter
What personality characteristics are you looking for in a dog?
Please check if you would consider a:
Special needs dog (i.e. - epileptic, handicapped)? Yes No
Senior dog? Yes No
Would you consider adopting a dog that MUST be crated when unsupervised (because of chewing, thunderstorm fears, separation anxiety, etc? Yes No
What is your primary reason for adopting a dog?

Indicate check any behaviors that are important to you:
Normally quiet
Friendly toward strangers
Doesn't shed a lot
Good watchdog
Good with children
Doesn't require professional grooming
Good with other dogs
Housetrained
Doesn't chew excessively
Can be trusted off-leash
Knows basic commands (sit, down, stay)
Good with cats

Are you looking for an indoor dog outdoor dog?
How much time (daily) would the dog spend: indoors outdoors
Where will you keep the dog when nobody is home?
Where will you keep the dog at night?
Who would be the primary caretaker of the dog?
Do you (and your spouse, if applicable) work all day? Yes No Yes, but opposite shifts .
Your Occupation:
Spouse's Occupation:
Does your job or your spouse's job require you to relocate? Yes No
If yes, how often?
What would you do with the dog if you had to relocate?
How many hours a day would dog be without human companionship?
How much free time do you currently have (hours per day)
How do you spend that free time?
How often do you travel?
What do you do with your pets when you travel?

Do you have children living in your home? Yes No If yes, please list ages
Do you ever have children visiting in your home? Yes No If yes, please list ages
Have the above children been around dogs on a regular basis? Yes No
Please list other adults living in your home:
How do they feel about adopting a dog?
Is anyone in your home allergic to dogs? Yes No Is anyone in your home afraid of dogs? Yes No

If you do not currently have a dog, how long has it been since you have owned one?
Have you ever successfully housetrained a dog? Yes No
Have you ever adopted a pet from a humane organization? Yes No
If yes, which organization?

Please answer the following questions with info about your current or most recently owned dog:
What activities do you participate in with your dog?
Have you attended obedience classes with your dog? Yes No Did you graduate? Yes No
Is/was your dog kept current on its vaccinations (rabies & DHLPP)? Yes No Unsure
Date of last shots
Do you give your dog heartworm prevention? Yes No What type (brand)?
What do you use to control fleas on your dog?
What do you feed your dog (brand/type)?
When nobody is home, where does your dog stay? Loose in the yard In a crate In the garage
In the house, confined to a certain area In the house, not confined to a certain area In the house w/ a doggie door In an outdoor dog run/dog pen On a chain / tie out Other (describe)
Is your dog spayed or neutered? Yes No Why or why not?
Who is/was your veterinarian?
Phone:

What type of home you live in? House Apartment Duplex Condo Mobile Home Click arrow for selection
Type of neighborhood: City/Urban Suburban Rural/Farming Click arrow for selection
Do you own your home? Yes No
If renting, give landlord's name and phone
Do you have a yard? Yes No Is it completely fenced? Yes No
If yes, what type of fencing do you have?
How high is fence? How do you secure the gate?
If no fence, how would you exercise a dog?

List all pets you currently own:

Breed/Species
Age
How long owned?
Sex Spayed/Neutered?
Stays Indoors or Outdoors?

Breed/Species
Age
How long owned?
Sex Spayed/Neutered?
Stays Indoors or Outdoors?

Breed/Species
Age
How long owned?
Sex Spayed/Neutered?
Stays Indoors or Outdoors?

Breed/Species
Age
How long owned?
Sex Spayed/Neutered?
Stays Indoors or Outdoors?

Breed/Species
Age
How long owned?
Sex Spayed/Neutered?
Stays Indoors or Outdoors?

Do you have more pets than those listed above? . Yes No
If yes, please list # of additional: dogs cats other

Have your current pets ever lived with a dog? Yes No .

List any pets you have previously owned:

Breed/Species
How long owned?
Spayed/Neutered?
Kept indoors or outdoors?
Where is pet now? If deceased, cause of death?

Breed/Species
How long owned?
Spayed/Neutered?
Kept indoors or outdoors?
Where is pet now? If deceased, cause of death?

Breed/Species
How long owned?
Spayed/Neutered?
Kept indoors or outdoors?
Where is pet now? If deceased, cause of death?

Breed/Species
How long owned?
Spayed/Neutered?
Kept indoors or outdoors?
Where is pet now? If deceased, cause of death?

Have you ever had to give away a pet? Yes No .
If yes, please tell us why:

Please list 3 personal references, NOT including your veterinarian:

Name
Address
Phone
Relationship

Name
Address
Phone
Relationship

Name
Address
Phone
Relationship

Briefly explain why you feel you would provide a suitable home for a rescued dog:

FORM SUBMISSION

Thank you for taking the time to complete this application. Please be assured that we ask these questions because we genuinely care about the dogs we are trying to adopt out. We consider the adoption of a pet a serious matter, and want to ensure the best possible match between pet and owner. Your application will be reviewed, and a home visit will be scheduled prior to final approval. You will be contacted if you are approved for adoption.

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