Adoption Application
Please fill out the following application completely. The adoption process is designed to match our dogs with the right home. WE WILL ONLY ADOPT DOGS INTO OUR REGION -which includes MD, VA, WV, DE, NJ, PA & NY (ie within a 6 hr drive of the rescue)
Typically our dogs require the safety of a fenced in area. There are exceptions to this depending on the dog and your overall environment/lifestyle. Please contact us with any questions. We also require applicants to provide us with photos of your home (outside, driveway, nearest road& inside common areas), and yard (proof of fencing).
Applicant Information
1. Name:__________________________________________________________________
2. Address:_________________________________________________________________
City:_______________________State:____________ZipCode:_____________________
3. Home Number:______________________Cell Number:__________________________
4. E-Mail:_____________________________________(Please Print Clearly)
5. Occupation:_____________________________________________________________
6. How did you hear about PWD?_____________________________________________
Home Life Information
1. How many children are in house?_________Ages?_______________________________
2. Do you have an active household with other children visiting frequently?_____________
3. Are there other adults in the household?_________Relationship to you?_____________
4. How many dogs have you owned in the past 5 years?_____________________________
5. Do you still own them? ______If no, please give reason.__________________________
6. How many Animals are currently living in your home?

Name/Breed
Sex
Spayed/Neutered?
Up to date on Vaccines?
Temperament (good with other dogs?)
1

2

3

4

7. Have you had a rescue dog before?_______From what organization?________________
8. Why have you decided to adopt a pet with a disability? ________________________________________________________________________________________________________________________________________
9. Please describe a day in the life of your dog in your home: __________________________________________________________________________________________________________________________________________________________________________________________________________________.
Home Information
1. Do you have a fenced yard?_________
2. if yes, What type of fence? ___________________Height:____________ Approximate area fenced in:________________
3. Do you own or rent your home?__________________
4. If you rent, can you provide written permission from your landlord to have pets?_____
5. Is your neighborhood urban, rural, or suburban?_______________________________
6. Do you live in a: Single Family Home____ Apartment ____ Condo_____ Mobile Home____

The Dogs Life
1. Will the dog be allowed to run loose?_________________________________________
2. Will he be tied out at any time?______________________________________________
3. How do you intend to exercise this dog?_______________________________________
4. How many hours will the dog be left alone?__________
5. Where will the dog spend the day?____________________night?__________________
6. Are you planning to enroll your dog in obedience/ training class?___________________
7. If not, how do you intend to train this dog?_____________________________________
8. What is the most challenging training situation you have previously faced with a dog? _______________________________________________________________________________________________________________________________________________________________________________________________________________________.
9. Do you have any prior experience with an animal with a disability?