First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Cell Phone

We only adopt within PA and will usually choose and adopter within an hour of the ranch in Windsor, PA. There are exceptions for further than an hour but we do NOT adopt out of state. Are you a resident of PA?

Please understand that if you do not own your own home or have children under the age of 5 we cannot approve you to adopt. These rules were put in place after issues with landlords and to protect young children and also rescue animals who are already stressed and may not be able to deal with a "busy" household. Thank you for understanding and wanting to help an animal in need. Please tell us how you heard about us! *

Please give us a short description of what you are looking for in your forever friend. Tell us what you know about the breed?*

Please describe your lifestyle. What do you like to do? How many hours a day are you actually home? If you have children what is their activity level like? etc....*

Your Name & Spouse Name*

Date of Birth of all people 18 and over living in your home*

Street Address, City, State and Zip Code*

If you live more than 45 minutes from Elizabethtown, PA please be aware you will be asked to email photo's of the inside/outside of your home and yard where the foster dog will live and play. A photo of your family and present pets will help the foster make a connection with you. Also we require a 2 visit system which means, if you are one of the 3 applicants chosen to meet the foster dog you will be invited for a visit and then if you are chosen you will need to return at a later date to pick up your new family member :-) We will NOT adopt to parents as a surprise for their child. All children must be 5 years or older. The whole family must be present for the visit and any dogs you already own must be introduced to the foster dog so that we can assess personalities before you will be considered for adoption of one of our dogs. Do you understand and agree to these stipulations?

Contact Phone Number*

Email Address

Facebook Address*

Employer & Position for you and your spouse*

List all people living in your home and their ages and birthdates*

Do you own or rent? If you rent please name your landlord and landlords phone number.*

Home Type?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

List all animals in your home at present time. Names, ages, breed, altered or not, up to date on vaccinations?*

Please describe the personality of your present pets and their breed.*

Veterinarian Name, Address & Phone Number. Please call your vet and give them permission to speak with us.*

Do your present pets see your vet on an annual basis? If not why and when were they last seen?*

Please list past pets and why they are no longer with you.*

If you have lost a pet through death please explain the circumstances of death? (Please include name, age, year pet died and veterinarian who cared for the pet.*

Would you ever give away an animal? If yes under what circumstances.*

If you have given away an animal please explain the circumstances.*

Please list a neighbor as a reference that we may contact. Name, Address and Phone #*

Please list 2 personal references that we may contact who have watched you interact with animals and have known you at least 5 years. No spouses or significant others please. Name, Address and best phone # to reach them at.*

Where will your pet sleep?*

Please describe your training plan.*

Please describe grooming plan.*

Do you have a fence? Yes/No If yes PLEASE list fence type*

Without a fence how will the dog be exercised?*

Do you plan to train your dog to be off leash at anytime?*

If you have answered "YES" when do you feel it is appropriate to be off leash*

If you are unable to care for your pet what will happen?*

If you were to need to move or took a job transfer what would happen to your pet?*

If your dog was found to have a serious illness during his/her lifetime and the treatment was going to be at least $1,000 what would you do?*

How many hours a day will your dog be left alone?*

Are you familiar with crate training? Will you be using a crate?*

Do you use air fresheners, incense, any smokers in the home? Smoke inside/out?*

Do you understand there is an adoption donation of $500 for dogs under 6 months of age, $400for dogs 6 months - 6 years old, $300 for dogs 7+ years old and that must be paid at the time the final adoption papers are signed? Unless the dog has had extensive medical treatments or they are older, then the adoption donation could be more or less.*
Choose one: Yes No

Arrangements will be made for you to meet the dog you are interest in. However do you understand and agree the animal will not become part of your family before, and unless, 2nd Chance 4 Life Rescue does an inspection of your home?*
Choose one: Yes No

I am in full agreement with 2nd Chance 4 Life Rescue terms and conditions of adoption. By initialing below, I attest to the truthfulness of my answers. I understand falsification of any of the above information will be grounds for disqualification as an adopter.*

By initialing below, I am indicating that I understand that by submitting this application, I am giving 2nd Chance 4 Life Rescue permission to check my criminal background, personal references and speak with my veterinarian.*

If you would like to tell us anything that was not addressed in our questions PLEASE place it here.