Application for Adoption

Name of Applicant # 1: *

Name of Applicant # 1:

Age of Applicant # 1: *

Age

Email for Applicant # 1: *

Confirm Email

Mobile Phone Number Applicant # 1: *

Mobile Phone #

Name of Applicant # 2:

Age of Applicant # 2:

Age

Email for Applicant # 2:

Mobile Phone Number Applicant # 2:

Mobile Phone Number

Street Address *

Street Address

City *

City

State *

State

Zip Code *

Zip Code

Are you currently employed? *

How many years have you been at your current job? *

Number of Years

Name of Current Employer: *

Name of Current Employer

Are you confident in your ability to care for the costs of adopting a dog? (food, veterinary care, etc): *

List all the names and AGES of the people living in the household: *

List all the names and AGES of the people living in the household:

Please confirm by signing here that all members of the household are in agreement with adopting a dog: *

First

Last

Do you have a yard? *

If yes, is it completely contained? *

If yes please describe: (type of fence, height of fence, material of fence, invisible fence etc):

If no, will you always leash the dog or tie the dog out or put on a runner? Describe it, and when/how long it will be used:

Do you own or rent (or other)? *

Rent
Own
Other

How long have you been at current location? *You may need to provide proof of home ownership, lease/landlord authorization. *

Please describe your current home (house/townhouse/condo/apartment/2 family/mobile home or other): *

If you do not own, have you already spoken to your landlord about adopting a dog? Explain why not?

Additional Pets in the Household - please list all (include breed and ages. If none, state none): *

Name and address of Veterinarian: *

Phone number of Veterinarian: *

Number of years with Veterinarian: *

If applicable, are current pets in home all current with vaccines? If not, why? *

Are dogs currently in the household on Heart Worm Prevention medications? If not, why? *

Which sex do you prefer to adopt? *

Male
Female

Describe 'other':

Describe 'other': (copy)

Approximately how many hours will the dog spend alone each day? *

Why are you looking to adopt a dog? *

Describe any preferences for color/hair type/size/ disposition/sex or other? *

Any known allergies to dogs? *

Do you have dog training or experience with handling dogs? *

Please describe your perfect dog(s)? *

Is there a specific dog (or dogs) you are interested in? If so please list Name(s):

Do you plan to enroll in dog obedience training within 4 weeks of adoption? *

If not, would you agree to enroll should the need arise? *

Would you agree to a home visit as part of the preadoption process? *

Agree to license and provide total health care for the dog? *

Agree to spay or neuter if this is not already done (ie. Too young)? *

Agreement to return the dog to POOPR if you cannot keep it? *

Signature: *

First

Last

What else would you like to share with us?

Reference of Unrelated Person: *

Name/Address/Phone

How do you know them? *

Reference of Unrelated Person: *

Name/Address/Phone

How do you know them? *

Reference of related or unrelated person: *

Name/Address/Phone

How do you know them? *

Signature and Agreement All Pooches Out Of Puerto Rico have an adoption fee of $500-$600 depending on the size of the dog and the air carrier costs etc. We understand that these costs are higher than most local humane society or adoption rescues, we recommend you consult with your local Humane Society to see about local dogs in need. In almost all cases the actual costs to rescue, vaccinate and provide veterinary care while in Puerto Rico, feed, secure airline approved food/water/collar/leash and crate, as well as transportation fees get the dogs/pups to San Juan cargo, and of course the actual air cargo fees, amount to more than our adoption fees. We are therefore personally committed with our time and resources to saving these dogs. Our goal is to host various fundraiser events throughout the year where we will invite our POOPR family so you can show off your pooches and support our cause further. Donations above your adoption fee are always welcome, but we rely on your to spread the word about these great animals in need so we can get more dogs into loving homes! We are currently asking that donations be made out to one of the following: · Bank of America: hard copy check you can mail to Marybeth Boruta (Co-Founder) 914 Blue Hill Road, Germantown NY 12526; this will go directly to the credit card used for POOPR and charge all vet/food/medication and collars/leashes and other equipment needed for transportation, as well as some airline fees · Kerri Corrigan: Co-Founder: Venmo @Kerri-Corrigan or PayPal paypal.me/kerricorrigan) for human transporter fees/airline fees, treats, collars/leashes and other equipment needed for transportation *

First

Last

Date *

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