Kansas K-9 ResQ

Adoption Application

Ready to give a rescue dog their forever home? Fill out the form below and our team will be in touch.

Applicant Information

Your Name*

Spouse/Partner's Name

Address*

City*

State*

Zip*

Occupation

Your Age*

Home Phone

Cell Phone*

Email Address*

Name of dog you are interested in adopting

Number of adults in home*

Number of children in home*

Ages of children

Are any family members allergic to dogs?*

YesNo

Housing Information

Do you own or rent your home?*

OwnRent

What size is your yard?*

SmallMediumLarge

Is your yard fenced?*

YesNo

Veterinarian & References

Your Veterinarian

Veterinarian Phone

Personal Reference 1

Name

Phone

Relationship

Personal Reference 2

Name

Phone

Relationship

Current Pets

List all pets currently in your home. Add a row for each pet.

Pet 1

Pet Name

Breed or Mix

Age

Sex

Spayed or Neutered

Where obtained

Have all of the above dogs been kept on year-round heartworm prevention given by your veterinarian?*

YesNo

Have all of the above pets been given recommended annual vaccinations?*

YesNo

Previous Pets

List pets you have owned in the past. Add a row for each pet.

Previous Pet 1

Pet Name

Breed or Mix

Age

Sex

Spayed or Neutered

What happened?

Have all of the above dogs been kept on year-round heartworm prevention given by your veterinarian?*

YesNo

Were all of the above pets given recommended annual vaccinations?*

YesNo

About Your Desired Dog

Why do you want a dog?*

Breed or mix preference

Why do you like this breed or mix?

Have you owned this breed or mix before?*

YesNo

Care & Living Arrangements

Will you commit to keeping and taking good care of this dog for its whole life?*

YesNo

Will you make this dog a part of your family and allow it to live in your house?*

YesNo

By submitting this application you confirm that all information provided is accurate. Kansas K-9 ResQ reserves the right to approve or deny any application.