(647) 614-8902

CANINE ADOPTION APPLICATION

Please be advised that filling out the application, does not indicate ownership of the animal described below. Often we will receive many
applications for the same pet, in which case we will process applications in order of suitability for that pet and availability of the family to adopt.
Please only submit your application if you are ready to adopt right away!
*First Name: *Last Name: Roy * Date:
Anisha
*Address: * City: *Province: Ontario*Postal Code:
547 Dorchester Drive Oshawa L1J 6L3
*Home Phone: *Cell Phone: *Email:

Rescue You’re Applying For:

Bubbles/Buttercup

1. I would consider my house to be… Hectic Noisy Active Average Quiet

2. My dog needs to be able to adjust to new situations Strongly Disagree Doesn’t Agree Strongly
quickly. Disagree matter Agree

3. I want my dog to be playful. Strongly Disagree Doesn’t Agree Strongly

Disagree matter Agree

4. I want my dog to be laid back. Strongly Disagree Doesn’t Agree Strongly

Disagree matter Agree

5. I am comfortable doing some training with my dog to Strongly Disagree Doesn’t Agree Strongly
improve manners such as jumping, stealing food and Disagree matter Agree
walking on the leash.

6. I am comfortable with a puppy that is not yet Strongly Disagree Doesn’t Agree Strongly
house-trained. Disagree matter Agree

7. I (or a person in my family) want to participate in Strongly Disagree Doesn’t Agree Strongly
agility, flyball or obedience with our dog. Disagree matter Agree

8. My dog may be exposed to… (circle all that apply) Large Small Other Birds Other
Dogs Dogs Cats

9. My dog may be alone… More than 9 hours 4-8 hours per day Less than 4 hours
per day per day

10. When I am at home, I want my dog to be by my Little of the time Some of the time Most of the time
side…
11. When I’m not at home, my In the garage In a crate In the yard Loose in the Confined to one
dog will spend his/her time house room in the house

12. My dog will spend the night… In the bed In a crate In the yard Loose in the Confined to one
house room in the house

13. My dog may be exposed to… Children Children Men Women Elderly people
(circle all that apply) under 8 over 8

14. Where do you live? House Townhouse Apartment Trailer Rent or Own?
specify rent or own ***

Note: If renting, a letter from your landlord approving said pet to live in their unit is required

15. I want my dog to serve as a type of therapy dog? If Yes why? Yes No

____________________________________________________________________________

16. My dog will be primarily… Inside Outside

17. I want a guard dog. Yes No

18. I want my dog to hunt or herd with me. Yes No

19. Do you have a yard? Yes No

20. If yes to above, is it fenced? Yes No

21. Do you smoke? Yes No

22. I have lived with cats before No Yes: How long ago? Currently

23. I have lived with dogs before No Yes: How long ago? Currently

24. Have you ever given up a pet? If yes why? __________________________________________________

25. If you currently have pets, who is your regular veterinarian? _______________________________________
What is your pet(s) name(s)? Breed(s)? Age(s)?: ______________________________________________________________

26. Do you authorize us contacting your regular vet to confirm that your current animals Yes No
are up to date on vaccines?

27. What food do you plan on feeding? Kibbles with boiled meat
_______________________________________

28. What pets currently live in the household? _______________________________________________________

29. Does anyone in your household have allergies to dogs? Yes No

30. If yes above, how do you plan to manage them? ___________________________________________________

 31. In the event that you are not selected to be the owner of the animal described Yes No
above, would you like us to keep your application on file in case a suitable dog is
available in the future?

32. If yes, would you prefer a Male Female

33. What age of dog would you prefer? Puppy or Adult Small
Do you have a size preference for the dog you are looking for? to Medium Large

34. Do you have any life altering plans in the near future? ex/ moving, long term travel, having a baby? Yes No
If yes, please describe:

35. If you had to rehome your pet, do you have a family member or friend to assist? Yes No Crazy, this would never be an option!

Disclaimer
Please be advised that no animals will be adopted out on a "trial basis". Please do your research to ensure you are ready to adopt at this time
and are willing to work with your new family member throughout their lifetime. In case of emergency, we will take the pet back within 7 days
Yes
and offer up to a 90% refund depending on the situation. If the animal becomes ill or is injured during the time s/he is with you, it is your
responsibility financially to provide medical care immediately. If you ever need to rehome your adopted pet in the future, please email us at
ultimuttpetrescue@gmail.com for us to assist.

Signed at:
Signature ________________________ 03/01/2023
Date______________________
2023-03-01 16:22:41

Staff Witness _____________________

Signature or Parent or Guardian if Applicant is under 18 ________________________________

References:
Baker Animal Clinic
Name/Relation: ________________________________ (905) 571-3700
Phone Number: ________________________________

Debarati Saha
Name/Relation: ________________________________ Phone Number: ________________________________

Comments:

In case you call the Vet, please refer by my current dog's name "Toffee"
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never