You can always press Enter⏎ to continue
Almost Home Dog Application
1
Today's Date
*
This field is required.
Previous
Next
Submit
Press
Enter
2
Full Name
*
This field is required.
Previous
Next
Submit
Press
Enter
3
Address
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Previous
Next
Submit
Press
Enter
4
Home or Cell Phone #
*
This field is required.
Previous
Next
Submit
Press
Enter
5
Email
*
This field is required.
email is necessary for notification
Previous
Next
Submit
Press
Enter
6
Name of Animal you are interested in adopting
*
This field is required.
Previous
Next
Submit
Press
Enter
7
Animal Type
*
This field is required.
Dog
Cat
Rabbit
Dog
Cat
Rabbit
Previous
Next
Submit
Press
Enter
8
Number of Adults In Home
*
This field is required.
Please Select
1
2
3
4 or more
Please Select
Please Select
1
2
3
4 or more
Previous
Next
Submit
Press
Enter
9
Number of Children In Home
*
This field is required.
Please Select
0
1
2
3
4
5
6 or more
Please Select
Please Select
0
1
2
3
4
5
6 or more
Previous
Next
Submit
Press
Enter
10
Ages of Children in Home
*
This field is required.
Previous
Next
Submit
Press
Enter
11
You Live In
*
This field is required.
Please Select
A House
An Apartment
A Condo
We Rent
Other
Please Select
Please Select
A House
An Apartment
A Condo
We Rent
Other
Previous
Next
Submit
Press
Enter
12
Do you
*
This field is required.
Please Select
Own Home
Rent
Please Select
Please Select
Own Home
Rent
Previous
Next
Submit
Press
Enter
13
Landlords Name & Phone # if you Rent
Previous
Next
Submit
Press
Enter
14
Pets You Currently Own in Your Home - NAME/TYPE/BREED/AGE/SEX/SPAYED/NEUTURED (if no pets - please enter none)
*
This field is required.
Previous
Next
Submit
Press
Enter
15
Minimum vet care can cost $200.00 per visit, can you afford this care?
*
This field is required.
Please Select
Yes
No
Please Select
Please Select
Yes
No
Previous
Next
Submit
Press
Enter
16
Vet's Name
*
This field is required.
Previous
Next
Submit
Press
Enter
17
Vet's Phone #
*
This field is required.
Previous
Next
Submit
Press
Enter
18
Does everyone in home know and agree to Adopting a Pet?
*
This field is required.
Please Select
Yes
No
Some
Please Select
Please Select
Yes
No
Some
Previous
Next
Submit
Press
Enter
19
How Many Pets have you owned previously (past 5 years)
*
This field is required.
Please Select
0
1
2
3
4
5 or more
Please Select
Please Select
0
1
2
3
4
5 or more
Previous
Next
Submit
Press
Enter
20
What happened to your last Pet
*
This field is required.
Please Select
died of illness
died of old age
hit by car
put to sleep
run away
gave away
other
Please Select
Please Select
died of illness
died of old age
hit by car
put to sleep
run away
gave away
other
Previous
Next
Submit
Press
Enter
21
How many Hours will the Pet be alone during the day?
*
This field is required.
Previous
Next
Submit
Press
Enter
22
Do you have a fenced yard?
*
This field is required.
Yes
No
Partially
Previous
Next
Submit
Press
Enter
23
If yes, how high?
*
This field is required.
Please Select
3 feet
4 feet
6 feet
different
Please Select
Please Select
3 feet
4 feet
6 feet
different
Previous
Next
Submit
Press
Enter
24
Are you familiar with crate training
*
This field is required.
Yes
No
Partially
Previous
Next
Submit
Press
Enter
25
Do you plan on crating this Pet
*
This field is required.
Yes
No
Partially
Previous
Next
Submit
Press
Enter
26
Do you have any experience with obedience training
*
This field is required.
Yes
No
Previous
Next
Submit
Press
Enter
27
Would you be willing to hire a trainer if problems arise?
*
This field is required.
Yes
No
Previous
Next
Submit
Press
Enter
28
Where will the Pet live?
*
This field is required.
Indoors
Outdoors
Both
Previous
Next
Submit
Press
Enter
29
Where will the Pet sleep
*
This field is required.
Previous
Next
Submit
Press
Enter
30
Provide a Reference that is not Family
*
This field is required.
Full Name & Phone # (family or friend)
Previous
Next
Submit
Press
Enter
31
Provide a Reference that is Family or Friend
*
This field is required.
Full Name & Phone # (family or friend)
Previous
Next
Submit
Press
Enter
32
May we visit your home before and after adoption?
*
This field is required.
Yes
No
Previous
Next
Submit
Press
Enter
33
ALMOST HOME RESERVES THE RIGHT TO REFUSE AN ADOPTION
*
This field is required.
agree
disagree
Previous
Next
Submit
Press
Enter
34
I / We Agree That If We Adopt a Dog or Cat or Rabbit, We Will Provide Professional Vet Care, A Nutritious Diet & a Loving Home
*
This field is required.
agree
disagree
Previous
Next
Submit
Press
Enter
35
I / We AgreeWe Will Return The Dog or Cat or Rabbit to Almost Home Animal Rescue If We Can No Longer Keep it
*
This field is required.
agree
disagree
Previous
Next
Submit
Press
Enter
36
No Member Of Our Household Has Ever Been Convicted of Cruelty to Animals
*
This field is required.
agree
disagree
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
36
See All
Go Back
Submit