Application

Please review the the Adoption Policies, Frequently Asked Questions and What to Expect pages before completing the application.

Hi potential adopter, thank you so much for taking the time to fill out this application. Some of our dogs have had a rocky start to life and the following questions are being asked to make sure that our SCCR pups are placed in the best environment for them. Some of SCCR dogs may have special needs/concerns about housing locations so please answer the following questions as honestly as possible. We respect and value diverse backgrounds and are committed to creating an environment that is inclusive and nurturing for all.

First Name

Last Name

Date of Birth

Email Address

Confirm Email Address

Cell Phone

Confirm Cell Phone

Street

City

Country

State

Postal Code

Please understand that we are a volunteer-based organization. Because of this, we keep the vast majority of our adoptions to the Chicagoland area. If you are outside the Chicago area, please email us at adoptions@sccrescue.org before completing an application.

Occupation

Employer (optional)

Are you applying to adopt a specific dog?

Dog Name

Some of our pups have special needs so it is important for SCCR to know who will be living with the new dog. Please let us know how many individuals will be living in the new dog’s household.

Please list all people (including you) that will be living in the household with your new dog

Yourself

Name

Age

Gender Identity

History of Dog Allergies?

Person 2

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

Person 3

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

Person 4

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

Person 5

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

Person 6

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

Person 7

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

Person 8

Name

Age

Gender Identity

History of Dog Allergies?

Aware of Possible Adoption?

How many other pets have you had within the last 10 years (including current pets)?

Please tell us about any current pets first and then other pets you have had in the last 10 years.

Pet 1

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered?

Still Own?

What happened to the pet?

Pet 2

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered?

Still Own?

What happened to the pet?

Pet 3

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered?

Still Own?

What happened to the pet?

Pet 4

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered

Still Own?

What happened to the pet?

Pet 5

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered

Still Own?

What happened to the pet?

Pet 6

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered

Still Own?

What happened to the pet?

Pet 7

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered

Still Own?

What happened to the pet?

Pet 8

Pet Name

Type/Breed

Age

Sex

Spayed/Neutered

Still Own?

What happened to the pet?

Primary Veterinarian and Phone Number Please note that SCCR reserves the right to contact applicants' veterinarians as a reference.

Housing Information

Housing Type

Single Family HomeMulti-family Home (townhome, condo, apartment, etc.)

Other Housing Type

Do you have a Landlord?

YesNo

Landlord's Name, Phone Number, and Email Address

Does your landlord, property manager or HOA have breed, # of pets or weight restrictions? If so, what are they? (Please plan to bring a copy of your lease, HOA regulations or a letter confirming acceptable pets when coming to meet a dog.)

Do you have a fence or designated outdoor area and is it enclosed?

YesNo

Type and height

Do you want a dog who is (check all that apply):

Very Active	Aloof	Protective	Medium Energy
Requires little exercise	Requires a lot of exercise	Requires no exercise	Friendly to family
Talkative	Shy with family	Friendly with visitors	Playful
Shy with visitors	Dog park friendly	Friendly	Independent
Couch Potato	Good in car	Affectionate	Goofy
Allowed on furniture	Fearful	Withdrawn	Play with toys
Agility classes	Likes to swim

Are you willing to work with a dog who needs additional support (training or medical)?

Please be aware that at the time of adoption SCCR will no longer be responsible financially.

What is your household's typical daily schedule?

Why are you considering adopting a dog?

Where will you keep the dog when you are at home?

Where will you keep the dog when you are not at home?

Where will the dog sleep at night?

How will you discipline the dog?

What behaviors are you and your family unwilling to tolerate regarding dog behavior?

SCCR requests that each adopted dog go through basic obedience training (using positive reinforcement methods). Are you willing and able to cover that cost at your own expense?

If a medical emergency arises, are you willing and able to cover that cost at your own expense?

Please be aware that at the time of adoption SCCR will no longer be responsible financially.

If you and your family move in the future, what will your plan be to ensure adequate care for your dog?

If you experience a major life change (medical emergency, change in marital status, birth of a child, etc.), what will your plan be to ensure adequate care for your dog?

Have you ever surrendered an animal to a rescue or shelter, or lost a pet due to something other than natural causes?

If Yes, what were the circumstances?

I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that Second City Canine Rescue reserves the right to deny my request to adopt an animal for any reason. I, along with those persons who may accompany me, assume risk of injury which may be incurred as a result of my viewing any animal under the care of Second City Canine Rescue.

YES

Please sign me up for Second City Canine Rescue's mailing list

YES

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Contact Information