Adoption Application

Step Three

This is the final (long) step of the application. Please complete and hit the submit button at the bottom.

Please be aware: We are an all-volunteer rescue with no paid employees. Your application is being processed by a volunteer who most likely has a job, a family, and other responsibilities. We ask that you please be patient with the process. You will receive a confirmation email after submitting your application (check spam if you do not see it). It can take 48-72 hours for the next step depending on how quickly we have someone available to review your information.

Adopt a Dog in Florida

Thank you for your interest in The Pixel Fund.
Please be aware: We are an all–volunteer rescue with no paid employees. Your application is being processed by a volunteer who most likely has a job, a family, and other responsibilities. We ask that you please be patient with the process. You will receive a confirmation email after submitting your application (check spam if you do not see it). It can take 48-72 hours for the next step depending on how quickly we have someone available to review your information.
Application to Adopt a Dog in Florida

We are unable to approve adoptions to residents of Massachusetts at this time.

Please complete all fields applicable to your application. Blanks fields will cause a delay in processing your application. If the question does not apply, please enter n/a.

Prior to the approval of your application, we require a vet check on your existing pets, a landlord check, if applicable, and a home visit. Some home visits are conducted in person, while others are conducted virtually. I understand that if I rent and do not provide contact information for my landlord on my application, my application will not be processed.

I acknowledge and accept these terms.

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Application Information
  Indicates required Field
First Name(s) of Applicant(s)
Last Name(s) of Applicant(s)
Physical Street Address
City
State
ZIP Code
Primary Phone Number
Alternate Phone Number
Work Phone Number
Email Address
Occupation
How did you hear about The Pixel Fund?
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Are you considering pet adoption from any other organization at this time?
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Pet Information
Which dog you are interested in? (leave blank if undecided)
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Is there another dog you are interested in?
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As an adult, have you been responsible for the care of a dog or cat in your home?
Yes or No?
How many total pets do you have in your home at this time?
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Current Veterinarian Name & Address (*please enter n/a if you do not have one)
Current Veterinarian Phone Numbe
Previous Vet Name (if you've seen them in the past 2 years)
Previous Vet Phone Number
I give my vet permission to release information to The Pixel Fund.
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I've notified my vet of my intent to adopt & gave permission to release info to The Pixel Fund.
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Pet #1 Information (Please list living pets who currently are in your home.)
Pet #1 - please list your current or previous pet's name
Pet #1 - gender
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Pet #1 - species
Pet #1 - Is Pet #1 spayed or neutered?
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Pet #1 - Does this pet still live with you? If not, what happened to the pet?
Pet #2 Information (Please list living pets who currently are in your home.)
Pet #2 - please list your current or previous pet's name
Pet #2 - gender
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Pet #2 - species
Pet #2 - Is Pet #2 spayed
or neutered?
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Pet #2 - Does this pet still live with you? If not, what happened to the pet?
Pet #3 Information (Please list living pets who currently are in your home.)
Pet #3 - please list your current or previous pet's name
Pet #3 - gender
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Pet #3 - species
Pet #3 - Is Pet #3 
spayed or neutered?
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Pet #3 - Does this pet still live with you? If not, what happened to the pet?
Housing Information
Do you rent or own?
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How long have you lived at your current address?
Renters Only: Landlord's Name (if own, put n/a)
Renters Only: Landlord's Contact Info (if own, put n/a)
Do you have your landlord's permission to have a dog?
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What type of pet are you allowed to have in your rented home? Check all that apply.
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If breed or weight restrictions apply, please list specifics here:
Are you able to do Skype or Facetime? In some instances, this helps us to do home visits more quickly or allows us to do visits in areas not close to our current volunteers.
Virtual Home VIsit
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When is the best time to do a home visit?
Additional Adopter Information - Getting to Know You
What is your family's activity level?
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List ages of all family members, including self, that live with your or visit often
Does anyone in your household have allergies to animals?
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Have you ever sold, given away, or surrendered a pet to a shelter?
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If Yes, please describe the circumstances.
Do you understand the state and local ordinances concerning vaccinations, licensing and leashing?
Yes or No
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Have you, or any member of your family/household ever been cited for leash law violations or cruelty to animals in the past?
Yes or No
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If Yes, please specify circumstances and dates
Dog Applicant Questionnaire
Are you aware the routine cost for owning a dog averages $500/dog/year?
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Where will the dog stay when you are away from the house?
How long will the dog be left alone on a typical day (without humans)?
Where will the dog sleep at night?
When you go on vacation who will care for your dog and where will it be cared for?
If and when you move, what will you do with your pet?
Will you put your dog on year-round heartworm preventative?
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Will the dog you are adopting be allowed in the house?
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How do you plan to help your new dog adjust to your home?
How do you plan on socializing your new dog?
What behaviors do you consider unacceptable?
What would happen if your dog developed a physical or behavioral ailment or problem that you felt you could not handle?
How will you handle excessive barking, fearfulness, jumping, aggression towards other dogs, chewing, potty accidents, separation anxiety, etc. should any of these issues arise? Please understand many of these actions are common during the first few weeks as the new pet adjusts to your home.
Dog Adjustment/Training Plan:
Please tell us a little of your lifestyle, your family including any special activities in which your dog would be included. If you have any requirements or requests for a dog, please let us know so that we can more carefully match a dog to your lifestyle
Dog matching info:
Release of Liability:
You will accept the animal and specifically release and hold harmless The Pixel Fund, Pixel’s Posse, Inc., and all of its agents, employees, directors, officers and volunteers from any and all claims and liability in connection with the animal for any reason, and you assume all risks and responsibilities for the care, transport, training and behavior of the animal, including any injury or damage it may cause to people, property or other animals, as well as any rules, regulations or requirements for the importation of pets into the state in which you reside (if you do not reside in Maine or Florida), and licensure and other local ordinances.
No warranties of any kind, including but not limited to health, temperament, viability, age or breed are made by The Pixel Fund. After 5 days, the adoption/re-homing fee is non-refundable and non-transferable.
Agreement:
I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we understand that completion and submission of this application does not guarantee adoption of a pet. I/we understand that any application and/or rehoming fee is non-refundable and is payable to cover the costs incurred by The Pixel Fund for shelter fees, veterinary care and medical attention, transport, and other expenses, including the care and feeding of its animals prior to adoption. No warranties are made regarding the health, history or temperament of this animal, express or implied. You specifically agree that your veterinarian, landlord and employer may release information to The Pixel Fund only with respect to information necessary to process this application.
By checking the box below and typing your name, you electronically agree to the terms and conditions outlined above
Submitted by (please type name):
Thank You! We will be in touch soon

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