Please print, fill out and send to the addresses on the application or feel free to fax it to us.

For Office use only:

Date Recd___________________ Adoption Approval Rep__________________________
H.V. Date__________ Approved____Yes ____No Approved w/ Conditions___Yes ___No

Dal-Savers Dalmatian Rescue, Inc.
P.O. Box 090151
Milwaukee, WI 53209-0151

Fax: (414)228-1182 (WI)
or
(815)874-1720 (IL)

Hot Line: IL (847)604-DALS (3257) Hot Line: WI (414)297-9210
E-Mail: LoveAdal@yahoo.com
Web Site: http://www.dalrescue.net

ADOPTION APPLICATION

Tell us why you want to own a Dalmatian
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
If no, what have you done to research the breed?_______________________________________________________________________ ___________________________________________________________________________

TYPE OF DALMATIAN YOU'RE LOOKING FOR
(The more flexible you can be, the shorter the wait could be.)

SEX    ___Male     ___Female     ___No Preference

COLOR  ___Black Spots     ___Liver Spots     ___No Preference

AGE RANGE            ___Up to 1yr     ___1yr-3         ___3yrs-5
           
                     ___5yrs-7        ___7yrs or up     ___No Preference

How long are you willing to wait for the best match?______Months

PERSONAL INFORMATION
Primary Adopter_________________________ Secondary Adopter______________________
Address________________________________ City_________________________________
State_________________________ Zip_____________ Home Phone(___)_______________
Primary Adopter Occupation____________________ Work Phone(___)__________________
Secondary Adopter Occupation __________________ Work Phone(___)__________________
Primary Adopter Email Address_____________________
Secondary Adopter Email Address___________________
How long at present address________ Do you ___own ___rent
If you rent, landlord name___________________________ Phone(___)________________
Do you live in a/an ___Apartment ___House ___Condo ___Townhouse
How many people reside in your home? _________Adults _________Children
Ages of children ______________________________________________________________
Does anyone in your home have allergies? ___Yes ___No If yes, who______________________
If you move in the future, what will you do with your dog?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

HOME ENVIRONMENT
Do you have a COMPLETELY fenced in yard? ___Yes ___No
If Yes: Height of Fence______________________ Type of Fence________________________
If no or if not completely fenced in, how will you contain your dog to your property? (Be specific)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Primary Adopter Work Hours ____________________________________________________
Secondary Adopter Work Hours__________________________________________________
How many hours per day do you expect the dog to be left alone? _________________________
Where will you keep the dog when no one is home? _________________________
Where will you keep the dog during the night when you are sleeping? _________________________
What will you do with the dog if you need to travel for personal business reasons?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

PET EXPERIENCE
List current animals you own:

Current veterinarian: Name ______________________________________________________
City______________________ State_________________ Phone(___)___________________

If you do not currently own a dog, have you owned one before in your adult life? ___Yes ___No
If Yes:

Are you willing to obtain a crate/kennel and crate train the dog if necessary? ___Yes ___No
Are you willing to enroll the dog in obedience training classes? ___Yes ___No
If yes, name of facility if you have one picked out: _____________________________________
If no, what are your plans for training the dog: (Be specific)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
How do you plan on exercising the dog?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
If you have never owned a dog in your adult life, please list two References:
Name: ___________________ Phone #: ________________ Relationship: ________________
Name: ___________________ Phone #: ________________ Relationship: ________________

MISCELLANEOUS
Rescued animals need time to adjust to a new home. Are you willing to give this dog adequate time to adjust to ensure proper adjustment - at least three weeks in some cases? ___Yes ___No
If no, how long do you feel is a fair amount of time to adjust? _____________________________
What would be unacceptable behavior in your home for you to want to give up the dog?
__________________________________________________________________________
__________________________________________________________________________
How did you hear about Dal-Savers? (Please check all that apply)

___Internet                 ___Family/Friend             ___Word of Mouth
___Newspaper Ad             ___Vet's Office              ___Groomer/Trainer
___Flyer Posted at local pet store ___Other________________________________

Are you willing to have a Dal-Savers representative visit your home by appointment prior to adoption? ___Yes ___No
If no, reason: __________________________________________________________________________
I understand that in order to complete processing of this application, a visit to my home is required. This will be scheduled by a representative of the Dal-Savers Organization and that by submitting this application, I agree to such a scheduled visit. I/We acknowledge that all the information contained on this form is true and correct. I/We understand that any misrepresentation of fact may result in removal of the adopted dog from my home by Dal-Savers Dalmatian Rescue, Inc.

_______________________________________________      ___________________

Primary Adopter's Signature                           Date

_______________________________________________      ___________________

Secondary Adopter's Signature                         Date