Forms

Adoption Application

First name

Last name

Phone

Birthday

Month

Day

Year

Address

What dog(s) are you interested in adopting?

Housing Type (Apartment, Condo, House)

Own or Rent?

If renting, does your landlord have breed specific restrictions?

Do you have a fenced in yard?

Household activity level?

Names and ages of all household members

Species, breed, age, size of all animals in your household?

Have you ever surrendered an animal previously? If so explain why

Is this pet a gift?

How will you provide exercise for your dog?

How many hours a day will your dog be left alone?

Where will your dog stay when you're away?

How long do you think it should take your new dog to adjust to living with you?

List at least two references (not family members) that can be contacted. List first and last names, and phone numbers.

Surrender Application

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Dog(s) Name(s)

Primary Breed, Secondary Breed if Applicable

Primary Color, Secondary Color if Applicable

Sex

Male

Female

Spayed Female

Spayed Male

Age Group

Puppy

Young (Under 2)

Adult

Senior (Over 7)

Estimated Age

Has your dog(s) ever bitten or tried to bite a person or animal? If yes, please explain

Are there triggering situations for your dog? (Loud noises, fast movements, ect.)

Is your dog microchipped?

How long have you had your dog(s)?

Where did you get your dog(s)?

Reason for surrender? Please give a detailed answer, the more detail you can provide the better we can help

Does your dog have an experience with other dogs or pets? If yes state species, age, sex, and breed of said pets

Does your dog have any experience with children?

List any past medical issues

List any current medical issues

Is your dog(s) up-to-date on vaccinations?

Please upload a current photo of your dog(s)

Forms

Adoption Application

Surrender Application

For more information, reach out

Call
(484) 364-9673

Email
genesispitrescue
@gmail.com

Surrender Form

Forms

Adoption Application

Surrender Application

For more information, reach out Call (484) 364-9673 Email genesispitrescue @gmail.com

Surrender Form

For more information, reach out

Call
(484) 364-9673

Email
genesispitrescue
@gmail.com