Rescuing, Sheltering and Rehoming Companion Animals in the Columbia Valley of BC since 2007

Dog Adoption Application

Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternative Phone
Email*
Do you have a specific ICAN animal in mind? Tell us its name
Your Family
Who are you adopting this animal for?
- Self
- Relative
- Child
- Friend
- Other
Have all members of your household been introduced to the animal?
- Yes
- No
Number 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 Often
- Often
- Sometimes
- Rarely
- Very rarely
Any severe allergies in your family?
- Yes
- No
Do you have a family vet?
- Yes
- No
- Not Yet
Veterinarian Contact Information:
Your Home
Type of home?
- House
- Apartment
- Acreage
Rent or Own?
- Rent
- Rent Shared
- Own
- Own Shared
Outside 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 inside
- Tied outside
- Garage
- Loose outside
- Crate
- Kennel run
- With me
How long will your dog be alone during the day?
Where will your animal stay during the night?
- Crate
- Loose in house
- Garage
- Outside
- Other
Where will your animal stay during vacations?
- At home with no care
- At home with care
- Boarded
- With a friend
Have you had dogs before?
- Yes
- No
What happened to them?
Have you ever surrendered an animal to a shelter?
- Yes
- No
Why?
How much daily exercise can you give your dog?
- Tons
- Lots
- Moderate
- Some
- Not Much
What 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?
- Yes
- No
Please give landlord’s name & phone number
Do you have other animals?
- Yes
- No
Please specify type and breed for #1
Temperament with other animals
- Friendly
- Disinterested
- Afraid
- Not Sure
Please specify type and breed for #2
Temperament with other animals
- Friendly
- Disinterested
- Afraid
- Not Sure
Please specify type and breed for #3
Temperament with other animals
- Friendly
- Disinterested
- Afraid
- Not Sure
Your References

References are required - Please list two references who can comment on your character and experience with animals. REFERENCES MUST NOT BE FAMILY MEMBERS
Reference 1
Name
Phone
Relationship
Reference 2
Name
Phone
Relationship
Desired Animal
Desired Sex
- Male
- Female
- Either
Coat
- Short
- Medium
- Long
- Either
Age
- Puppy
- Adult
- Senior
- Any
Breed, Type or Colour?
Be friendly with people/pets
- Very Important
- Important
- Not Important
Further Details:
Approximately how much do you think your dog will cost you per year?
Problems you are willing to work on
I'm interested in working on problems
- Yes
- No
- Depends
Behavioural Problems
- Separation Anxiety
- Excitablility
- Mild Aggression
- Obedience
- House Training
- Fearfulness
- Barking
- Digging
- Chewing/Destructiveness
Be friendly with children
- Very Important
- Important
- Not Important
Be friendly with other dogs
- Very Important
- Important
- Not Important
Be friendly with cats
- Very Important
- Important
- Not Important
Be friendly with visitors
- Very Important
- Important
- Not Important
Enjoy being groomed
- Very Important
- Important
- Not Important
Enjoy being held
- Very Important
- Important
- Not Important
Be calm
- Very Important
- Important
- Not Important
Enjoy being active
- Very Important
- Important
- Not Important
Never show aggressive behaviour
- Very Important
- Important
- Not Important
Some of our dogs require training…
- Yes
- No
- Not Sure
I need a dog that is already trained
- Yes
- No
- Not Sure
I am a first time dog owner
- Yes
- No
I have obedience trained before
- Yes
- No
I have lots of experience and could handle a difficult dog.
- Yes
- No
- Not sure
Under 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 week
- One to two weeks
- One month
- As long as it takes
Agreements
Have you ever been convicted of neglect or cruelty to animals?
- Yes
- No
Are you willing to have an ICAN representative do a home visit by appointment?
- Yes
- No
If 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
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Dog Adoption Application

Your Family

Your Home

Your Pets

Your References

Reference 1

Reference 2

Desired Animal

Problems you are willing to work on

Agreements