Adoption Application

This is our standard application that must be filled out prior to adopting any of our dogs. If you are interested in a specific dog, there is a place to indicate that toward the bottom.

Thank you for considering a rescue dog!

"*" indicates required fields

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Welcome to the application process with A Canine Gem Rescue (ACGR). We are responsive to applications received so that we can get our GEMS into homes as soon as possible because they deserve it. Our adoption process moves quickly. Applicants generally hear from ACGR within 24 hours of submitting an application.

Are you ready to adopt within the next 5 days?*

(if no, STOP, you will not be able to proceed with our application process.

Yes

Have all household decision makers agreed to start an adoption process with ACGR?*

(if no, STOP, you will not be able to proceed with your application process)

Yes

As we operate by APPOINMENT ONLY, do you prefer weekday or weekend appointments?*

Weekday

Weekends

What day of the week would you prefer to make your appointment?*

Monday

Tuesday

Wednesday

Thursday

Friday

What day of the week would you prefer to make your appointment?*

Saturday

Sunday

What time between 10am – 4:30pm is preferable?*

Who needs to come to the meet and greet appointment? You must schedule a time where all decision makers can come to our facility together.*

You Live (Town)*

You Live (State)*

You live how many miles away from Plattsburgh, NY?*

You live how many hours how many mins/hours away from Plattsburgh, NY?*

If you live more than 120 miles, 2 hours away from Plattsburgh, do you have your own vehicle to get to our rescue facility in Plattsburgh, NY?

Yes

If no, how do you plan to get to our facility?*

NOTE WE DO NOT TRANSPORT OUR RESCUE DOGS TO POTENTIAL ADOPTERS. ADOPTERS MUST COME TO OUR FACILITY IN PLATTSBURGH, NY TO MEET OUR DOGS AND COMPLETE ANY NECESSARY PAPERWORK.

Adopter acknowledges, that A Canine Gem Rescue does not offer transportation to adopters*

Yes, I acknowledge

Name of applicant*

First Last

Age of primary applicant*

Name of spouse/significant other*

First Last

Age of spouse/significant other*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email address of applicant*

Enter Email Confirm Email

Email address of spouse/significant other*

Enter Email Confirm Email

Phone number of applicant*

Confirm phone number of applicant*

Phone number of spouse/significant other*

Confirm Phone number of spouse/significant other*

When is a good day/time between 9am and 6PM to call the applicant(We are closed on Sundays)?*

About You and Your Home

How many ADULTS(18 YRS AND OLDER) live in the home?*

How many children live in the home?*

Child Name*

Child Sex*

Male

Female

Child Age*

Child Name*

Child Sex*

Male

Female

Child Age*

Child Name*

Child Sex*

Male

Female

Child Age*

Child Name*

Child Sex*

Male

Female

Child Age*

Child Name*

Child Sex*

Male

Female

Child Age*

Does anyone in the house hold have allergies?*

Yes

If yes, which family member and to what*

Does anyone in the household have a physical disability?*

Yes

If yes, which family member and please describe the disability*

Does anyone in the household have a mental/emotional disability?*

Yes

If yes, which family member and please describe the disability*

Description of household daily schedule:*

How many hours/day will the dog be home alone?*

Do You Have a Fenced-In Yard?*

Please describe including height, size, type of fencing*

What type of home do you have?*

Do you own or rent?*

If you rent, please provide your landlord or property manager name, phone number and email address*

How long have you been at your current residence? (years, months)*

If less than 2 years, please list your previous residence

How long were you at your previous residence?

What type of home was this?

Are there other pets in the house?*

Please list type, age, sex, spayed or neutered*

If there are no pets currently in your home, have you ever owned a pet before?*

What happened to your last pet(s)?*

Veterinarian name and phone number?

As it takes most dogs 4-6 weeks to decompress after leaving a rescue facility, how long would you give a dog to adjust to your home?*

What might cause you to RETURN a dog to our program?*

If you determined that you needed to return a dog to our program, how long would you give us to take this dog back? Remember we only have so much space. So once you commit to a canine, he/she is yours until we can take him/her back physically into our program.*

Do you need a dog that is good off leash?*

Are you willing to bring a dog to obedience school and/or seek trainer advise and classes?*

What type of dog are you interested in?*

Do you prefer male or female?*

Is there a dog listed on our website that you are inquiring about? If so, please list their name

What size of a dog are you interested in*

Toy (under 12 lbs)

Small (12-30 lbs

Medium (30-45lbs)

Large (45-70lbs)

Giant (over 70 lbs)

Agreements

Please check each box to affirm the following:*

I HAVE READ AND AGREE TO THE ADOPTION AGREEMENT, LINK BELOW

I WILL PAY THE ADOPTION FEE

THANK YOU FOR COMPLETING OUR APPLICATION. This greatly helps us to make a match with your household. We will be in touch with you shortly. You will receive a phone call from 518-420-7482 so please be on the look out for our call.

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Name

This field is for validation purposes and should be left unchanged.

Read our Adoption Agreement