1930 W
35th Street
Steger, IL 60475
FAX-708-503-0621
The Plantation Animal Rescue reserves the right to
refuse adoption to anyone. No animals will be adopted to prospective
owners who mislead or fail to provide accurate information on the adoption
application. Please type your information at the end of each question line
in the application. Please be sure to answer ALL of the following
categories and sections completely. An incomplete application will not be
considered. You may also add an additional narrative page if you desire.
Send your completed application to The Plantation Animal Rescue in one of
the following ways:
1.By e-mail to: fancydals@ameritech.net
2.By FAX to 708-503-0621
3.By mail to 1930 W 35th Street, Steger, IL 60475
Today’s date:
Full name(s) of applicants:
Your complete address (street, city, state, and zip;
also include P.O. Box if you receive mail by PO):
In case we need to contact you, please give your
Home phone number:
Work phone number
Cell phone number:
Your E-mail address:
Your Date of Birth
Drivers License Number
Are you inquiring about a particular dog? (Please
state which one or ones)
ii.What sex would you consider? (male, female, or
“any”)
iii.What age category are you interested in?
Are you familiar with the Dalmatian breed, and its
general traits and characteristics?
If yes, how?
Give an example of the actual size you are looking
for.
How long have you been looking for a dog?
Is this your first pet? Yes No
Is this your first Dalmatian? Yes No
YOUR HOME:
Do you live in a home, apartment, mobile home,
duplex, or condo?
Please describe your home
How long have you lived there?
Do you rent/lease or own your own home?
If you rent, does your lease allow pets? Yes____
No ____
If you rent, what is your landlord’s name?
__________________________
Phone: ______________________________
If you move in the future, what will you do with your
pets?
What would you do with them if you couldn’t take them
with you?
YOUR HOUSEHOLD:
List all the members of your household and include
their names, ages and relationship.
Do all the members of your household know that you
are trying to adopt a dog and agree with it?
Do you run a daycare in your home, or do at-home
baby-sitting for others?
YOUR RESTRICTIONS:
Are you aware of your township’s/city’s restrictions
and regulations regarding dogs, and agree to abide by those restrictions
and regulations?
How many dogs can you legally have on your property?
List every pet you currently own. Please include
their type/breed, age, size, and how long you have had them and where they
are kept
Name Breed Age/Size
How long owned Kept where
1.
2.
3.
4.
5.
6.
Are all of your pets up-to-date on shots and
vaccinations?
Rabies
DHLPPC
Heartworm Preventative?_____________ 6 or 12
months?_____________________ What Brand?
Have they been spayed or neutered? If not, please
explain why
Did you have any other pets in the past 10 years?
What kind?
What happened to them? (please state name, breed and
EXACTLY what happened to them)
What problems have you experienced with your pets,
and how did you handle them?
Veterinarian where your pet(s) records are located.
Please include vet’s name
Clinic name
City, State, Zip
Telephone number, including area code.
YOU MUST GIVE THIS VET PERMISSION TO RELEASE YOUR
PET’S MEDICAL HISTORY. This is a mandatory reference for this rescue. If
you do not have a veterinarian, and you are a previous pet owner, explain
why not. If you have never been a pet owner, state that, and please supply
the information on the veterinarian that you would use.
How many adults live in your household? _______
_
How many children? _______
Do all the adults know that you plan to adopt?
___________
If there are children in the household, what are
their ages?
Do you, or does anyone living in your household have
any known allergies to
animals? Yes_____ No_____. If yes, to what
kinds of animals, and how severe is the allergy
Who will be responsible for the care of this pet?
Where will this pet be kept during the day?
Where will this pet be kept during the Night?
How many hours will it spend alone without human
companionship?
Where will it be kept when alone
DOG ADOPTIONS ONLY:
Do you want the dog for a (check all that apply)
house pet ____
guard dog_____
Watch dog____
companion___
gift_____
companion for another pet_______
Hunting________
obedience/agility___________
therapy______
other______
Do you have a fenced yard? Yes_____No_______
If yes, how high.________
What kind of fence is it? (board, chain link, etc.)
How will you keep your dog confined to your property?
In house____
patio___
kennel_____
fenced yard_____
on chain_____
garage_____
on leash_______
List 3 Personal references with Phone numbers (NO
RELATIVES OR WORK NUMBERS)
1)____________________________________________
2)_____________________________________________
3) ____________________________________________
Have you ever applied to adopt from a Rescue
or Humane Society to adopt a dog or cat before?
Results?
What organization?
YOUR OCCUPATION AND FREE TIME:
Please state your occupation and your spouse’s
occupation
Approximately how many hours each day would your dog
be alone? (i.e.: none, 1-3 hours, 4-6 hours, 7-9 hours, 10 or more hours).
Where would the dog be kept when it is alone?
How long would your dog be left alone outside when
you are at home?
How long would your dog be left alone outside when
you are not at home?
To facilitate the bonding process, we recommend every
dog owner attend some introductory obedience
training. Are you willing to participate in a formal
obedience training program? ______
If not, please provide a brief explanation:
If No, what method will you use to train your
Dalmatian?
How much time and effort do you want to devote to
training your dog?
What would be your response if your dog made a
mistake?
What is your initial reaction to the idea of
disciplining your dog?
What is your definition of disciplining a dog?
If everyone in the household works during the day,
where will the dog spend its time?
Are you familiar with crating a dog?
Are you financially able to care for a new pet?
(feeding, routine vet care:
Vaccinations, parasite checks, emergency vet care,
licensing, etc.) Yes___ No___
How will you provide for your dog when you must go
out of town or on vacation?
Are you willing to take responsibility for this dog
for the rest of its life?
Can you: Make this commitment for the many years
this dog could live? (10-18 years)
Do you realize that Dalmatians shed 365 days a year?
Are you able to exercise your Dalmatian?
What methods will you use to exercise your Dalmatian?
Are you aware a bored Dalmatian will chew?
THE “NEW” DOG:
It can take a couple of weeks to a month for a new
dog to adjust to its new home and your routine.
Are you prepared to be “understanding” during this
time period?
What concerns do you have about this adjustment
period?
It is not uncommon for a dog to have “potty
accidents” when it changes its “home”, routine, and human “family” for as
much as 3 or 4 weeks. It will be confused, and confronted by all new
people, routines, surroundings, and expectations. If your new dog has an
“accident”, how would you deal with it?
What form of discipline would you use with the rescue
dog, if you become its adoptive family?
Do you understand that if for any reason you can no
longer keep the dog, that you are responsible for, and bound by, the
adoption contract to return it to this rescue?
The proper care of the adopted dog is a priority. Do
you understand that it would be your responsibility to keep the dog
up-to-date with vaccinations, check-ups, heartworm preventative, and
necessary treatments should you become the adoptive family?
Not to do so, would result in a breach of contract.
Should you become the adoptive family for one of our
rescue dogs, we ask that you keep in contact with us periodically during
the first year to let us know how things are going. We appreciate knowing
how the dogs are doing, and also in receiving photos and “happy
adoption”/”happy ending” letters to share with others. Would you agree to
this?
I agree to provide adequate food, shelter, water,
medical treatment and humane treatment at all times.
I understand that The Plantation Animal Rescue
reserves the right to investigate the care, treatment and environment of
adopted animals at any time, and has the right to immediately remove any
animal adopted through them, if they feel it's in the best interest of the
animal. Adoption fees will not be refunded after a period of 2 weeks.
VERIFICATION:
I hereby state that I have thoroughly read and
understood the adoption process through The Plantation Animal Rescue, and
furthermore, by submitting my application:
I attest that I have carefully read and completed all
of the questions.
I agree to its conditions.
I understand that falsification of any of the
information will be grounds to disallow my application from any dog from
The Plantation Animal Rescue.
By filling in my name below, I hereby give The
Plantation Animal Rescue permission and authority to process my
application and investigate the statements made in this application.
By signing or typing my name below, I give The
Plantation Animal Rescue permission and authority to process my
application and contact my references
.
Upon adoption, The Plantation Animal Rescue
relinquishes all responsibility of the adopted pet to the new adoptive
owner. The Plantation Animal Rescue will not be held liable for any
personal liabilities or damage to property or financial indebtedness
incurred for the care of the adopted animal after adoption.
