Dog Adoption Application

Brooklyn Animal Action is a 501c3 all volunteer organization committed to improving the
lives of animals in distress. Working with our communities, we facilitate Trap-Neuter-Return
programs, find homes for adoptable animals, perform community outreach and education,
and engage in advocacy. We believe in working together to create a better life for New
York’s animals.

Not every person who desires to adopt a dog should do so. It is our policy to make certain that each
person who adopts a dog is aware of the responsibilities of pet ownership and is capable of and
willing to accept those responsibilities morally, physically, and financially. By completing this
questionnaire, you will aid us in determining if you and your family are indeed ready to become
responsible pet owners. Should you agree that adopting a pet is a commitment throughout the
lifetime of your companion animal, please fill out this questionnaire and return to Brooklyn Animal
Action.

DOG’S NAME:

PERSONAL INFORMATION

Name: Age:

Name of Spouse /Partner / Roommate:

Address: City: State: Zip:

Home phone: Work phone:

Cellular phone: E-mail:

Occupation: Occupation Address:

Work schedule:

Spouse’s occupation:
Spouse’s work schedule:

Names of all persons living in your household, their relationship to you and their ages:

Name: Relationship:

Age:

Name: Relationship:

Age:
Please list three personal references and their relationship to you (ONLY ONE FAMILY MEMBER):

Name: Relationship:

Phone:

Name: Relationship:

Phone:

Name: Relationship:

Phone:

YOUR HOME
Type of dwelling? House Building Condo Other
Do you have a yard? Yes No Fenced? Yes No
If yes, height of fence?

Is there a pool on your property? Yes No Fenced? Yes No

Your Home has: 1 story 2 stories Own or Rent

If not a homeowner, do you have the landlord’s permission to have a dog?

If renting, what are the building rules about pets?

Landlord’s name: Phone:

YOUR PETS
Do you presently own a dog ? Yes No

Have you previously owned a dog ? Yes No

Have you ever trained a dog? Yes No

If yes, what type of training?

CURRENT PET(S)
Species & Breed: Owned how long?

Age: Sex: Altered: Yes No

How & why obtained? Kept indoors or outdoors?

PREVIOUS PET(S)
Species & Breed: Owned for how long?

Age: Sex: Altered: Yes No Kept indoors or outdoors:

What happened?

Have any of your dogs/dogs ever had puppies? Yes No

If yes were they breed for: Fun Profit Show Accident

Has any member of your family ever experienced animal – related allergies? Yes No
YOUR FAMILY VETERINARIAN:
Name: Phone :

YOUR NEW DOG

What is your primary reason for adopting this dog? Please circle one.

Companion Guard Dog Business Fighting Attack Dog Other:

Who will be responsible for the care of the dog?

Why do you think you want this particular dog?

What do you like most and least about owning a dog?

Where will the dog live? Indoor only Outdoor Only Indoor & Outdoor

Do you have any of the following? Balcony Pet Door Unscreened windows or doors

Does your home have any other means of outdoor access for a dog?

If /when you travel how will you provide for the dog while you are away?

What provisions would be made for the dog if you had to move to a place where no pets are allowed?

Locally:

Out of State:

Under what circumstances would you not keep the dog? Please circle.

Divorce Moving New Baby New Job Potty- training problem

Chewing furniture /carpet/drapes Biting people Fleas Allergy Shedding

Conflicts with Children Conflicts with other pets Dog became ill High veterinary costs

None of the above Other (please explain):

What would you do if the dog grew bigger than expected?

Return the dog to the shelter Keep the dog outside Other:

If the dog becomes ill or injured, are you financially prepared to provide medical care?

Yes No

If yes, is there a maximum amount you would spend? Yes No

What would that amount be? Reason

Are you financially prepared to provide proper food and grooming for your dog? Yes No

Do you have a dog walker/day care provider for the dog? Yes No
Please list all names and phone numbers of all care providers:

Name: Phone:

Name: Phone:

Please add any other comments you may have in regards to adopting this pet.

Applicant’s signature/date: __________________________________________________

(Digital signature will be considered a legal signature)

Applicant’s Confirmation: The answers to the above questions are true to the best of my knowledge. In addition, I agree to
spay/neuter the animal within the time frame given to me at the time of adoption, barring medical restrictions. I will not give
the animal, or otherwise transfer the animal to another party without notifying Brooklyn Animal Action and giving them first
right of refusal. If the animal is ever lost, I will contact the independent rescuer first and then Brooklyn Animal Action second
immediately to assist me in locating the lost animal. I realize that failure to comply with the adoption contract and the above
stipulations may result in confiscation of the adopted animal. The individual rescuer reserves the right to inspect the cat’s
disposition when deemed necessary.

Proposed Adoption Application Timeline:

Following is our approximate timeline for adoptions so you can follow the process with us and know what step you are
on/what the normal turn-around times are, not always in this order:

1. Potential Adopters submit applications

2. Application is reviewed (48 hours)

3. Meet & Greet scheduled

4. Delivery and Adoptions Agreement signed, $200 for seniors, $250 for adults, mixes, $300 for puppies and breeds. The
fee includes the cost of spay/neuter (if not already done and you bring animal back to us for spay/neuter). Please note each
dog costs us a minimum of $400 and the difference is paid out of our own pockets or through additional fund raising efforts.

5. Rescuer provides you with medical records for adopted dog, tax-deductible donation letter, copy of contract

FOLLOW UP DATES:

First night

First week

Your Independent Rescuer’s Information:

Name: Claire C E-mail: catskittensnyc@gmail.com

**Please retain this information for your records.

JOIN THE BAA COMMUNITY!

Visit BrooklynAnimalAction.org to connect with our Facebook, Twitter and Tumblr accounts! You can also sign
up for our monthly newsletter! We regularly feature our success stories, so be sure to send us your photos and
updates about animals you’ve adopted with us to BrooklynAnimalAction@gmail.com. We look forward to
hearing from you!