A 501(c)(3) Non-profit Organization
www.namasteakitarescue.com Email: info@namasteakitarescue.com
P.O. Box 418, Lafayette, CA  94549

AKITA ADOPTION APPLICATION

Today’s Date:_______________	Name of Akita you’re interested in:______________________ 
	
YOUR INFORMATION

Applicant’s Name:__________________________________      Email:___________________________
Address: ____________________________________________________________________________
Ph (w).:_______________________     (h):____________________  (m):_________________________

C0-Applicant’s Name:________________________________     Email:___________________________      
Address  if different than above: _________________________________________________________
Ph (w).:_______________________     (h):____________________  (m):_________________________

HOME

How long have you resided at your current address:___________ If less than 1 year, provide previous address:_____________________________________________________________________________
Do you have plans to move?__________     When and where?_________________________________
Do you own or rent the property?________________________________________________________	
(If you rent or have an H.O.A, you will be required to provide written documentation dogs of this size and breed are allowed)

If you own your home, what company is your home owners insurance with?_______________________
Have you confirmed your home owners policy will cover you if own an Akita?______________________
Which best describes your home:  condo_____,  house____,  apartment_____,  other_______ ________
Is your entire property securely fenced? __________    Fence material and height?__________________
If your yard is not fenced, are you willing to build a fence or buy an outdoor kennel?________________
Do you have a crate? __________    If not, are you willing to purchase one? ______________________ 
 
Would you consent to a home check? ____________  

EMPLOYMENT

Occupation of Applicant: __________________ Years with company:__________________________
Employer’s name & address:____________________________________________________________  
What is your work schedule, hours away from home:________________________________________

Occupation of Co-Applicant:________________ Years with company:__________________________
Employer’s name & address:____________________________________________________________  
What is your work schedule, hours away from home:________________________________________

Would you be willing to provide references to verify employment if requested? __________________

HOUSEHOLD/PREVIOUS PETS

Are there other adults living in your home?_______________________________________________
What is their relation to you?_______________________________________________________

If you have children who live with you OR visit on a regular basis please list their names, ages and relation to you: ______________________________________________________________________

Describe in detail, the type of education you have provided to the children about how to treat, respect and behave around dogs ________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Is anyone allergic to dogs?________________   Is anyone afraid of large dogs?___________________

List any current animals in your home.  If you own a dog list breed, age, temperament, gender______
____________________________________________________________________________________
If you’ve owned Akitas previously please describe their temperament __________________________
____________________________________________________________________________________
What happened to your previous animals?_________________________________________________

EXPECTATIONS/TRAINING

Will the Akita be in contact with animals outside the home?   Please explain____________________
___________________________________________________________________________________
What is your expected daily routine with the Akita?_________________________________________
Describe the ideal Akita personality, characteristics for your lifestyle __________________________
___________________________________________________________________________________

Why do you wish to adopt an Akita?  Please check all that apply.
____As a companion for myself
____As a companion for a family member
____As a companion for another pet, if so, please describe the pet___________________________
____As a guard dog 
____As a gift, if so for whom?___________________________
____As a therapy or service dog, if so, for whom?__________________________________________
_____Other (please explain)____________________________________________________________ 

Common Akita traits you should be aware of
Akitas should never be off leash in an open area (such as a park, street, unfenced yard) 
Akitas are commonly dog aggressive and generally cannot co-exist with dogs of the same gender   
Akitas have a strong prey drive and may hurt small animals such as cats, birds other small dogs       
Akitas blow their coats throughout the year     
Akitas are naturally dominant and should attend obedience training with all family members    

Please note any comments, concerns about the above:_____________________________________
___________________________________________________________________________________

Do you still think that the Akita is the right dog for you? _____________________________________
What age range are you looking for in an Akita? ____________________________________________
Do you have a preference for a male or female Akita? _______________________________________
Do you have a preference?   Purebred____________    Akita mix___________  Either______________
Which of the following have you used to train a dog (check all that apply):
Leash corrections _____     Praise_____     Food/treats _____   Toys _____   Verbal corrections _______

Which of the above were effective and why: _______________________________________________

Have you ever taken your dogs to basic obedience training? __________________________________
If so,where?__________________________________________________________________________

Describe two behavior problems you have worked through and how you solved the problem. (Problems such as soiling in the house, growling, pulling on the leash, won't come when called, etc.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

CONTAINMENT & CARE

How many hours will your Akita be alone daily?  ____________________________________________
How do you plan to contain the dog outside on your property? 
1)  dog run/kennel_____   2) tie out______  3) invisible fence/shock collar______  
4) other (explain)_____________________________________________________________________

Where will the dog be when you are at home:______________________________________________
Where will the dog be when you are away?________________________________________________
Where will your Akita sleep at night?   Inside_________  Outside____________  

How will you exercise your Akita and how often? ___________________________________________
Where and by whom?__________________________________________________________________

Who will care for your Akita if you are away overnight or on vacation?__________________________
Describes your household activity level: quiet_____  serene ____   some activity ____  very active____

How would you describe the amount and type of visitors or guests at your residence: 
1) few visitors ____    2) many visitors   ____   3) adult visitors ____
4) child visitors____  5) teenage visitors____ 6)  workers/gardeners, etc. that have access to the yard and or residence______

Annually, how much do you anticipate spending for veterinary care and food? ___________________

**Akitas are prone to certain illnesses and health conditions that can be life threatening and/or expensive and time consuming to manage such as: VKH, Sebaceous Adenitis, bloat, hip dysplasia, PRA, etc.  Are you aware of this?  Have you researched the breed specific health conditions they can develop?  Are you prepared to provide for your Akita both financially and emotionally if they should unfortunately develop an illness such as this? ______________________________________________

Under which of the following circumstances would you surrender your Akita:

1)	Divorce 	2) Moving	3) New baby	4) Not enough time	5) Dog too old                 6) New puppy	7) New spouse/partner doesn’t like the dog     8) other (please explain) 
_____________________________________________________________________________

Have you appointed someone to care for your Akita should you no longer be able to provide for him/her due to illness, accident or any other reason?  If so, who is that person and what is their relation to you? ______________________________________________________________________

The vet clinic that will be caring for your dog is:
Clinic Name:_________________________________ Vet's Name: ______________________________
Address: _______________________________________________ Phone:_______________________ 

Is everyone in your home in agreement with the adoption of this dog? _________________________
Who will be responsible for the care and wellbeing of the dog?________________________________
Is everyone in the household willing to participate in the care and training of the dog?_____________
Have you ever relinquished an animal to a shelter or rescue group, or sold/given an animal away?  If yes, please explain when and why________________________________________________________
____________________________________________________________________________________

REFERENCES

Please provide 2 references (not related to you), who know you and your animals.  If you've adopted from a rescue organization previously, please provide the dog's name and the rescue contact information.
1) Name:____________________________ Phone:_______________  Email:_____________________
2) Name:____________________________ Phone:_______________  Email:_____________________
3) Rescue Organization:_____________________________Phone/Email:________________________
4) Veterinarian (Dr. and Clinic name): _____________________________________________________
Phone:____________________________  Email:____________________________________________

Please feel free to add any other information you think would be helpful for us to know___________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

The information I have provided in this document is correct and true to the best of my knowledge and I have not withheld any pertinent information. I understand that any misrepresentation of myself or my family or any untruths of the information I have provided herein that are discovered at a later date, will invalidate any adoption agreement and will give NARA the right to reclaim the Akita without my permission and without refund of any adoption donation. Submittal of this form provides my agreement to this adoption application and gives my permission to NARA to contact my landlord (if applicable) and references, including my veterinarian. 

Applicant Signature_______________________________ 		Date_________________

Print Name______________________________________

C0-Applicant Signature____________________________ 		Date__________________

Print Name______________________________________

Namaste Akita Rescue Alliance, Inc.							                                  Rev 3/17