Adoption Application Form

PO Box 63401           Philadelphia, PA 19114          877-BLIND-01            www.blinddogrescue.org

Thank you for your interest in adopting a dog from our rescue. Please answer all questions to the best of your ability. Missing information may cause a delay in processing your application.
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Are you interested in adopting a particular dog on our site?

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If this dog is not available, would you consider another?

Please list all members of the household who are OLDER than 21
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Please list all members of the household UNDER the age of 21 and their age
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If renting are pets allowed?
Please give your landlord permission to speak with us and answer our questions
* Do you have a fenced in yard?
* Do you have a pool?
* Do you have a doggy door? Please note that having a doggy door does not automatically disqualify you from adopting
* Do you currently own other pets?

Current Pets

Please list any dogs you currently own:

* Do you own any cats?
If so, how many?
* Do you own any other animals?
Are any of your pets visually impaired?
* Do your pets visit your veterinarian at least once a year for a checkup?
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Please provide the following information about your veterinarian, if you have one:
Please call your vet and give permission to release information to us.
* Have you ever given away any of your animals for any reason?
* Have you ever lived or worked with a blind or visually-impaired dog?
* Do you understand and accept that changing a dog's environment, may cause the dog to have accidents, especially in the early days of the adoption?
* Are you willing to take the time to work with a pet on housebreaking issues should the need arise?
* Do you agree to a home visit by a representative of BDRA prior to adoption?
* If, for any reason, you are unable to keep the dog, do you agree to notify BDRA immediately?
* Do you also agree to return the dog to BDRA at your own expense?
Please list 3 references, preferably who have known you more than 2 years (only one family member).
Please let them know that you have listed them as a reference and give them permission to answer our questions.
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I understand that there is an adoption fee of $250, which partially defrays BDRA's costs of a vet check and any needed medical care.  

I understand that for unaltered animals there is an additional one hundred dollar ($100.00) spay/neuter deposit that is refundable upon BDRA receiving proof of spay / neuter and rabies vaccination.

I certify that I am at least 21 years of age and that I will be the legal owner of, and ultimately, solely responsible for the care and well-being of any dog I adopt from BDRA. 

I understand that any misrepresentation of the true facts in this application or in the adoption agreement will invalidate the adoption agreement and will give BDRA the right to reclaim the dog without refund of the adoption fee. 

I understand that an electric fence may not be used with any BDRA dog at any time.  

I understand that by clicking “Submit” below, I agree to all of the above. 

* Indicates Response Required