A Program of the Central Pennsylvania Animal Alliance
	Application to Adopt Fortune Pet's Name:  Name:          Date:  Address:  City: State:  Zip:   Home Phone:   Work Phone:    Cell / Mobile Phone: E-mail Address:      Work E-mail Address:   Number of adults in the household: Number of children in the household: Men:            Ages:   Women:      Ages:   Boys:    Ages:  Girls:      Ages:  Are you expecting a child or planning a family in the near future? yes  no Are all family members in favor of adopting a rescued American Eskimo Dog? yes  no If no, please explain: Type of Dwelling:  House     Apartment    Trailer    Modular Home Condo/Town  Duplex/Triple   Other - explain: if other: Do you own or rent?  own     rent How long have you lived at this address? Are you planning on moving in the near future? If you rent, do you have the landlord’s permission to keep a dog?     yes   no n/a Landlord / Manager's Name: Landlord / Manager's Phone:   How many consecutive hours a day are you away from home for work, school, etc.? Will you be hiring a pet sitter if gone a long time, or are you close enough to go home during the day?    Part II: Type of Rescue   Why do you want to adopt an American Eskimo Dog? companionship watch dog company for my current pet(s) Other reason, please explain: Are you agreeable to returning the dog, should an unforeseen circumstance arise wherein you would no longer be able to keep the dog?  This is a requirement through Eskie Rescuers United and the rescuers lists on this web site. Have you applied with another rescue organization recently? If so, which organization?       Part III: Environmental Information   How large is your yard (approx.)?   Is it securely fenced?   yes   no Do you have the invisible fencing? (Electric)   yes   no If yes, what kind and how tall?   If no, will you fence it if you get a dog?     yes    no  n/a Do you agree to keep a current ID tag on your adopted American Eskimo Dog at all times?    yes    no If no, please explain:   Do you have a pool?   yes    no If yes, is it securely fenced?     yes    no   n/a   If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise?     Where will the dog sleep?   Do you plan to keep the dog primarily indoors or out? Please elaborate Do you plan to use a crate for housebreaking or while you are gone?    yes    no Why or why not?  Part IV: Pet History   List All Pets You Currently Own:  Dogs: Breed Age Male or Female Spayed or Neutered? Stay Indoors or Outdoors male female yes no In Out male female yes no In Out male female yes no In Out male female yes no In Out Cats: Breed Age Male or Female Spayed or Neutered? Stay Indoors or Outdoors male female yes no In Out male female yes no In Out male female yes no In Out   Where did you get this dog (s)? What activities do you participate in with your dog:  Have you attended obedience classes with your dog?  yes    no What type of Heartworm Preventative do you give your dog?  What type of flea control do you use on your dog?  What do you feed your dog (brand/type)? When nobody is home, where does your dog stay? Select One In the yard In a crate In the garage In the house (but confined to areas) In the house (not confined to areas) In the house with doggie door In an outdoor run/pen Do you allow your current pets on your furniture?    yes   no        n/a Would you allow a rescued Eskie on your furniture?    yes   no        Is your dog spayed or neutered?    yes   no          Why or why not? Do you consider your current dog(s) aggressive or submissive to other people? animals? Please Explain: What circumstances, in your mind, justify giving a dog up?  (Check all that apply) moving new baby not getting along with other pets divorce getting out of fence behavioral problems children lost interest if it gets too big too time consuming shedding allergies housebreaking problems medical problems aggressive behavior                                    other - please explain: Have you ever given a dog up or had a dog for a brief period of time and it didn't work out? Yes No If yes, please explain the circumstances and what happened to it: If your pet later develops a medical problem that becomes expensive, what would you do? Find another home for him   Pay whatever it takes   Have him put to sleep   Give him to a rescue group or shelter   Other - please explain:   List any pets you have previously owned: Species/Breed How Long Owned Kept Indoors or Outdoors? Spayed Or Neutered Where is pet now? If deceased, cause of death? In Out yes no In Out yes no In Out yes no   Part V: American Eskimo Knowledge Are you aware that Eskies are warning barkers and just not "YAPPERS??       Yes No If yes, what problems do you foresee (please explain)?   Are you willing to take care of said problems should they arise even if he/she requires obedience training? Are you aware that Eskies shed 365 days a year?  Yes No Are you aware that Eskies "Blow Coat" (Seansonal Shedding: Fall & Spring) minimum 2 times a year? , Yes No And if not, can you accept this? Yes No   Eskies are companion animals, they will want to be with you constantly. Eskies were bred solely for companionship and to be warning barkers. Are you prepared for this? Do you realize that Eskies can live upwards of 20+ years and are you committed to care for it that long? Please let us know anything else that would make you an ideal candidate for a rescued American Eskimo Dog:    Part VI: Behavior   What type of behavior(s) do you expect from this dog? What amount of time and effort, per week, do you want to devote to training your dog?     3-5 hours    5-7 hours    7-10 hours       10+ hours Are you likely to enroll your dog in obedience class?     yes    no Which family members would be expected to assist in home training? What is your definition of disciplining your dog?  What are your training objectives? Who will be the primary caregiver for this dog (i.e. feeding, walking etc.)     List three references that can attest to your suitability as a pet owner, and more specifically, the owner of a rescued dog. If you own any pets now, please include your veterinarian as a reference. (THIS IS A REQUIREMENT)   Part VII: References ***NOTE: 3 References Are REQUIRED*** Please provide first your veterinarian reference, second and third are to be personal references. Family References Are Not Accepted. Reference #1 Vet Reference (First if applicable) Name   Street City State  Zip Phone Relation(if not vet): Do you have a current veterinarian yes   no        n/a E-mail address:   *If you do not have a veterinarian presently, you are required to find a reputable, licensed veterinarian within your area that you will be comfortable with prior to adoption. An Executive Director will be in contact with you if you do not have a veterinarian presently.* Reference #2 You must know your reference for a minimum of 2 years. They do not have to live in the same state. Family References Are Not Accepted. Name   Street City State  Zip Phone   Relation: E-mail address:   Reference #3 You must know your reference for a minimum of 2 years. They do not have to live in the same state. Family References Are Not Accepted. Name   Street City State  Zip Phone Relation: E-mail address:       **In rescue we deal with the unknown and usually we do not have full medical histories on our rescues. Eskie Rescuers United and its rescuers discloses any and all information known about its rescues prior to every adoption. In addition, all rescues are spayed or neutered, current on shots, and heartworm negative prior to placement. Some might be in heart worm treatment and may not go to their new forever home prior to the treatment being finished and retested to make sure they are heart worm negative. They are also treated for all known medical conditions while in foster care. Medical conditions and behavioral issues may arise after a placement and because there is no way to predict these issues, Eskie Rescuers United and its rescuers will not be held responsible for any costs incurred after the adoption. By sending this application, you understand the above terms and conditions.** Thank you for your adoption application through Eskie Rescuers United. I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated. Signature: Date:
	Hounds of Prison Education A Program of the Central Pennsylvania Animal Alliance