Dog Adoption Application Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Alternative PhoneEmail* Do you have a specific ICAN animal in mind? Tell us its nameYour Family Who are you adopting this animal for?SelfRelativeChildFriendOtherHave all members of your household been introduced to the animal?YesNoNumber of adults at home? Adults (18+ yrs)Number of young children at home? (0-7yrs)Number of children at home? (8-17yrs)Are they experienced with small animals? (required)*Children visit my home...Very OftenOftenSometimesRarelyVery rarelyAny severe allergies in your family?YesNoDo you have a family vet?YesNoNot YetVeterinarian Contact Information:Your HomeType of home?HouseApartmentAcreageRent or Own?RentRent SharedOwnOwn SharedOutside areas? (Please check all that apply) Balcony Patio Enclosed Yard Partially enclosed yard Open yard Busy street Quiet street Your Pets Who will be the animal's primary caretaker?Where will your animal stay during the day?Loose insideTied outsideGarageLoose outsideCrateKennel runWith meHow long will your dog be alone during the day?Where will your animal stay during the night?CrateLoose in houseGarageOutsideOtherWhere will your animal stay during vacations?At home with no careAt home with careBoardedWith a friendHave you had dogs before?YesNoWhat happened to them?Have you ever surrendered an animal to a shelter?YesNoWhy?How much daily exercise can you give your dog?TonsLotsModerateSomeNot MuchWhat would you enjoy doing with your dog? On leash walking Swimming Off leash park Hiking Jogging Do you have the landlord's permission to have pets?YesNoPlease give landlord’s name & phone numberDo you have other animals?YesNoPlease specify type and breed for #1Temperament with other animalsFriendlyDisinterestedAfraidNot SurePlease specify type and breed for #2Temperament with other animalsFriendlyDisinterestedAfraidNot SurePlease specify type and breed for #3Temperament with other animalsFriendlyDisinterestedAfraidNot SureYour References References are required - Please list two references who can comment on your character and experience with animals. REFERENCES MUST NOT BE FAMILY MEMBERSReference 1NamePhoneRelationshipReference 2NamePhoneRelationshipDesired Animal Desired SexMaleFemaleEitherCoatShortMediumLongEitherAgePuppyAdultSeniorAnyBreed, Type or Colour?Be friendly with people/petsVery ImportantImportantNot ImportantFurther Details:Approximately how much do you think your dog will cost you per year?Problems you are willing to work onI'm interested in working on problemsYesNoDependsBehavioural Problems Separation Anxiety Excitablility Mild Aggression Obedience House Training Fearfulness Barking Digging Chewing/Destructiveness Be friendly with childrenVery ImportantImportantNot ImportantBe friendly with other dogsVery ImportantImportantNot ImportantBe friendly with catsVery ImportantImportantNot ImportantBe friendly with visitorsVery ImportantImportantNot ImportantEnjoy being groomedVery ImportantImportantNot ImportantEnjoy being heldVery ImportantImportantNot ImportantBe calmVery ImportantImportantNot ImportantEnjoy being activeVery ImportantImportantNot ImportantNever show aggressive behaviourVery ImportantImportantNot ImportantSome of our dogs require training…YesNoNot SureI need a dog that is already trainedYesNoNot SureI am a first time dog ownerYesNoI have obedience trained beforeYesNoI have lots of experience and could handle a difficult dog.YesNoNot sureUnder what conditions would you return your animal to ICAN? Aggressive Too timid Wrong Decision Destructive House Training Does not get along with other pets Too costly Not enough time Animal's health problems New baby How long will you give your new animal to adapt to his/her new surroundings?Less than a weekOne to two weeksOne monthAs long as it takesAgreementsHave you ever been convicted of neglect or cruelty to animals?YesNoAre you willing to have an ICAN representative do a home visit by appointment?YesNoIf no, why?Tick the checkboxes below to indicate to us you completely understand and agree to the following statements. It is my responsibility to see and evaluate this puppy/dog for myself before agreeing to adoption This puppy/dog will reside in my home as a companion. I will provide him/her with adequate food, water, shelter, affection, socialization and medical care I will not sell, trade, give away or otherwise dispose of this puppy/dog. If at any time I am unable OR unwilling to care for this puppy/dog, I agree to contact ICAN to return him/her to ICAN or to discuss finding him/her a new home ICAN is in no way liable or responsible for any damage, accident or injury resulting from the placement of a puppy/dog into my household ICAN cannot be held responsible for any health or temperament problems of this puppy/dog I will inform ICAN of any changes to my contact information Your comments:Falsified information will lead to automatic rejection of the application. ICAN reserves the right to refuse any applicant. I declare that all information provided in this application is true and complete.* I Agree ICAN DISCLAIMER: ICAN exercises due diligence and will disclose all known previous history for each rescue animal we place. ICAN is not liable for any unforeseen behaviors that might arise after adoption. ICAN does our best to access and provide as much information as possible on each animal that comes into our care and expects that all Adopters are aware that new situations may have the potential to bring out unknown issues. We also ask that all Adopters agree to not surrender any animal we place for euthanasia unless that is the only option or course of treatment recommended by a licensed Veterinarian. All Adopters must agree to not declaw any animal adopted through ICAN. Declawing is illegal in British Columbia and Nova Scotia and ICAN adopters hereby agree not to declaw in any other province in Canada. THANK YOU FOR COMPLETING THIS APPLICATION FORM. THIS INFORMATION WILL HELP US MATCH YOU WITH THE RIGHT DOG FOR YOUR FAMILY CAPTCHA