Dalmatian Rescue of Colorado Adoption Form

Thank you for your interest in adopting a Dalmatian! Please fill out this application on line and a member of Dalmatian Rescue will contact you. You must have TWO personal references and a veterinary reference. NOTE that a home visit is also required to adopt a dog from us. We PREFER
that you submit your application electronically as this creates less work for us. But if you must print and mail it to us we will still accept it. Please Press the submit button once when finished to send your application.

melodee101@gmail.com

PLEASE FILL OUT ALL APPLICABLE FIELDS

DALMATIAN RESCUE OF COLORADO, INC. RESERVES
THE RIGHT TO REFUSE ADOPTION TO ANYONE.

Please note that filling out this questionnaire is not a reservation or guarantee of a dog.

Full Name
Spouse/Partner Name
Age
Street Address
City	State (for Canada, enter CAN) Zip
Mailing Address (if different then above)
Phone Home:	Work: Cell:
Email Home:	Work:
Best Time to Call:

How did you hear of Dalmatian Rescue? Dal Owner Advertisement Web Other

Have you previously adopted a dog from Dalmatian Rescue of Colorado? Yes No If yes, please answer the following section:

Dog's Name? Date of adoption
Do you still have this dog? Yes No If no, please explain why:

Why do you want to own a Dalmatian?

Please specify what age/sex/color of Dalmatian you are looking for (if you have a preference):

Do you consider yourself/family to be active in such a way that it would include your Dalmatian? How?

Have you ever owned a Dalmatian?Yes No

Do you have other dogs now? Yes No If Yes, please answer the next section:

Dog's Name Breed Age Sex Spayed/Neutered?

Dog #1

Dog #2

Dog #3

If your dog(s) is (are) not spayed or neutered, are you willing to have them spayed or neutered? Yes No

How often are they fed? Watered or dry? Watered Dry Brand:

How do your dogs get along with other dogs? Excellent Good Fair Poor

Have you ever bred a litter?Yes No

Have you ever trained in obedience? Yes No Willing to train in obedience? Yes No

Do you own cats? Yes No

How many? Are they used to dogs? Yes No

Do they live indoors or out? Indoors Outdoors

What other animals are in the house, i.e., rabbits, gerbils, hamsters, ferrets, etc.:

Previous pets (dogs/cats) owned:

What happened to them?

Veterinarian Information:
Do you have a veterinary reference? Yes No If yes, please complete Veterinarian info below.
If no, please indicate the reason:

Veterinarian Name:
Address:
Phone:

Personal Reference #1 Information:

Name:
Address:
Phone:

Personal Reference #2 Information:

Name:
Address:
Phone:

Do you have a fenced yard?

Fence height (ft): Fence type

If "Other", please explain fence type:

Is fence completely enclosed on all sides and also attached to the house? Yes No

What kind of shade or cover is in the enclosure?

Please describe your yard, including approximate size, level or hilly, grass or other ground cover, etc.

What kind of accommodations do you have for the dog in the cold and in the heat?

Is anyone home during the day? Yes No Hours the dog would be alone

Where will the dog stay during the day when alone?

Do you have a dog door? Yes No

If you have a dog door, does it go into the house or garage? House Garage

Describe neighbors the dog will be involved with (Do they like dogs? Children (ages), dogs or cats?)

Any problems with neighbors currently? Yes No

Do you own your home? Yes No

If not, please send a letter of permission from your landlord to have a Dalmatian.
Give landlord's name, address, and phone number.

What do you do with your pets when you go on vacation?

Do you own and have you used a dog crate? Yes No

How old are any children who will be in contact with the dog?

Does anyone in your family have asthma, or allergies to cats? Yes No

If yes, how severe?

Do all parties (if more than one adult in house) want a Dalmatian? Yes No

Are you aware that there might be a two-week to one-month adjustment period for any adopted dog?
Are you willing to give the new dog at least a one month adjustment period after adoption?
Yes No

Would you consider a second Dalmatian at a future date? Yes No

We are always in need of temporary homes for our rescue dogs. Would you be willing to foster
a needy Dalmatian if it is compatible with your life style and other pets? Yes No

Any other questions about the breed we can answer?

I understand and agree that Dalmaitan Rescue of Colorado, Inc. (DRCI) may refuse my adoption contract for any reason whatsoever and that submission of this application is in no way a guarantee of acceptance or placement. I further state and affirm that all information provided by me on this application is true and correct to the best of my knowledge and is subject to verification by DRCI, its officers or assignees and further understand that falsifying information will result in my application being denied..

I agree to these terms

If a Dalmatian is placed with me/us, I/we agree to cooperate with Dalmatian Rescue of Colorado, Inc. (DRCI) in its attempt to provide a smooth adoption. I also agree to contact DRCI about problems that might arise in the future. Should the dog need to be placed, or euthanized (prior to normal old age), I agree that I will contact DRCI first and will return the dog to DRCI at a location designated by DRCI. I further agree during the natural life of this dog that I will NOT take this dog to an animal shelter nor sell or give this dog to anyone else without express written authorization from DRCI.

I agree to these terms

Every reasonable effort is made to screen each Dalmatian for health and temperament problems before making the dog available for adoption through DRCI. However, DRCI, its officers, board of directors, and agents cannot guarantee the health or temperament of the Dalmatians available for adoption other than what is known at the time of adoption. DRCI assumes no liability for any problems arising from an adopted Dalmatian in the future.

I agree to these terms

For each Dalmatian adopted we request a minimum donation, to help cover expenses incurred, payable at the time of adoption:

Dog is at least	Requested Donation **
8 Weeks Old	$200.00
1 Year Old	$150.00
10 Years Old	$100.00
Second or Third Dog	$100.00

** Unless a different adoption donation is specifically mentioned on the dog's biography page.

I agree to these terms