To submit an application fill out the below information or you may download the application by clicking “Dog Application (PDF).
Please answer all questions fully and honestly. No discriminations will be made. Alchemy Acres provides an environmental adoption service to help you adopt a pet that will best fit in to your home. We make every attempt to screen our animals for health issues and behavior issues. Some problems may not present under our circumstances or may become apparent after a length of time. We make no guarantees but ask for your patience and respect toward both our animals and our volunteer staff.
If unemployed please specify how you intend to care financially for your dog’s necessities.
Please provide information for other household members at this time (please include children and temporary members/roommates or frequent visitors)
Please detail if you currently rent, lease or own your home and property where your home is located. This section also applies to those who must accomidate a home ownership association or like entity.
Please answer the following inquiries
Please detail any pets that you have owned or currently own. If you have never owned a pet you are welcome to list childhood pets or family pets to complete your application.
Please notify your references that they may be contacted by a representative of Alchemy Acres. Veterinary References are mandatory, please give your vet(s) permission to speak with us regarding your account(s).
- Dog Adoption Application
- Applicant Information
- Employer Informaiton
- Household Information
- Home Ownership Information
- Reference Section
- Agreement, Release and Signature
Name of Dog Requesting or Description of the type of dog(s) you would be interested in.
Name of Dog Requesting
Applicant Information (Must be 21 years of age or older) A Photo ID will need to be provided at time of visit.
Applicant Full Name
Mailing Address (or SAME)
City, State, Zip
County of Residence
Primary Phone Number
Secondary Phone Number
Date of Birth
Provide a VALID Photo ID Number and State
Name of person(s) in house hold with main income
City, State, Zip Code
Work Phone Number (with extension)
Please List Person name, age, relationship to the applicant
Please indicate the type of housing and environment the pet will have.
Area surrounding the home
Enclosure available to pet
If there is fencing what type and how tall?
Describe the ownership information
Name of homeowner.
How long have you lived at this address?
Name on title/deed
Name of complex or association
County, City, State, Zip Code
Phone Number of owner or management
Is there a pet deposit, if so has it been paid?
Is there a monthly fee for pets?
Are you aware of any rules of limitations for pets set by a landlord?
Have you notified your landowner that you are seeking a pet?
Would you allow an Alchemy Representative to visit your home?
Are there any active military members living in the household?
How many times have you moved in the past 10 years?
If you move after the pet adoption will your pet go with you?
Have you ever lived in a home that did not allow pets?
Does anyone in your household smoke? (This question is asked to consider the animals that may have a pre-existing health concern).
How would you describe your home environment with a pet?
Are you able to provide a permanent home for this dog's life (please consider longevity, financial care and medical necessities)
Are there any major illnesses in the home that may be affected by the presence of a new pet (i.e. allergies, breathing conditions, physical challenges).
Do you foresee any major changes in the next 15 years?
Specify any reason you wish to adopt a pet.
Mark any reason you would justify to give up a pet. Most pets need an acclimation period when entering a home to adjust. Some pets may develop issues over time. This question applies to what you feel you are unable to adapt to or handle?
Please describe an exercise plan for your new dog
Please describe your plan for housetraining and schedule for toilet duties
Do you plan on keeping a collar with ID on your Pet?
Approximately how often or how many hours will the pet(s) be left alone on a traditional day?
Where will the dog(s) stay on a typical day with a family member at home?
Where will the dog(s) stay when home alone?
Would you be willing to adopt a pet with a pre-existing Medical need?
Most pets develop medical needs as they age, do you feel prepared to financially and physically aid the pet?
Are you willing to care for a pet that has pre-existing behavioral issues like anxiety, extra training needs or possession issues?
Most pets from a shelter will exhibit some forms of anxiety during their acclimation period which will most often resolve. If an issue like this arises or another issue, do you feel capable of caring for the dog?
Have you had any pets or found any other animal that has died of an unknown cause potentially being ParvoVirus, Distemper or another Zoonotic Disease on your property?
Have you ever had to have an animal euthanized (put to sleep)? If Yes, please elaborate why.
Have you ever surrendered an animal to a shelter or pound? If yes, please elaborate.
Have you ever given a pet away to another home? If yes, please elaborate.
Will you agree not to surrender the pet you adopt from Alchemy Acres to anyone other than Alchemy Acres should the situation arise in the future?
Have you ever adopted from Alchemy Acres? If yes, who and when did you adopt?
How did you hear about Alchemy Acres?
PREVIOUS pets (pets that you no longer have) Please put most recent pets first and go backward as far as 10 years if you need to. Please use details such as Pet Name Type (i.e. dog, cat) Breed Age Gender Spayed or neutered? Up to date medically i.e. Shots, Preventions Living Environment (indoor/ outdoor). Also include the reason you no longer have the pet
Please describe your previous pets
Current Pets, this includes other family members pets that live in the household, pets that visit frequently, indoor/outdoor pets, livestock and temporary pets belonging to other people. Please use details such as Pet Name Type (i.e. dog, cat) Breed Age Gender Spayed or neutered? Up to date medically (i.e. Shots, Preventions) Living Environment (indoor/ outdoor) Any Health conditions?
Please detail your current pets
Secondary Caregiver (this would be the person(s) your pet would revert to in the event that you could no longer provide care.
Secondary Caregiver's Name
Secondary Caregiver's City and State of residence
Secondary Caregiver's phone number
Your relationship to the Secondary Caregiver
Reference City and State of Residence
Reference Phone number
Your relationship to reference
Veterinary Reference #1
Name of Veterinary Clinic
City and State of Veterinary Clinic
Phone Number of Veterinary Clinic
Name that your account is under at the clinic
Veterinary Reference #2
Name of Veterinary Clinic
City and State of Veterinary Clinic
Phone number of Veterinary Clinic
Name that your account is in at the clinic
Signature and Date
If considered an approved adopter, I accept the animal as is and assume all risks of its ownership, including the risk of injury or damage caused by the animal (such as animal bites.) On behalf of myself, my heirs, personal representatives, and assigns, I hereby release ALCHEMY ACRES ANIMAL SANCTUARY Inc, Campf’s Service Co, Inc, and it’s directors, officers, employees, and agents from any and all claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection with my adoption. By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of an AAAS dog and possible removal of an adopted dog from the home. Applicants must be 21 years of age or older. ALCHEMY ACRES ANIMAL SANCTUARY Inc. reserves the right to refuse any applicant. By signing below, I affirm that the facts set forth in it are true and complete. I understand that any false statements, omissions, or other misrepresentations made by me on this release may result in probable legal action. To the best of my knowledge, I have accurately and truthfully filled out this release form and by signing below understand that said animal is released to Alchemy Acres Animal Sanctuary, Inc. (If a minor, a parent or legal guardian signature is required)