ADOPTION APPLICATION
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| Today's Date |
| First Name |
| Last Name |
| Address |
| City |
| State |
| Zip |
| Work Phone |
| Home Phone
Required |
| Cell Phone |
| Email |
| Are you interested in a specific dog? YesNo |
| Which one |
| Would you consider a Mix YesNoMaybePrefer Mix |
| Do
you have a gender preference |
| Do you have a color preference YesNo |
| If yes
what color |
| Are
you looking for indoor or outdoor dog |
| What
Age Range are you looking for |
| Please list the characteristics you'd like in your new pet: (check all that apply) |
| Good with children |
| Good with other pets |
| Playful |
| Dominant |
| Loving |
| Independent |
| Shy |
| Protective |
| Active |
| Feel
free to list Other Characteristics |
| Please list what rolls in the home you'd like your new pet to fill (check all that apply) |
| Companion Family Pet |
| Protection |
| Therapy |
| Obedience Trials |
| Hunting |
| List
any Other Rolls |
| To facilitate the bonding process each new dog should attend some introductory "obedience training" classes. Would a formal obedience training program be something that you would be interested in? |
| YesNo |
| If No obedience class explain |
| Residence:
|
| If you rent please give the Owner's Name & phone number below |
| Owners Name |
| Owners Phone |
| Where
will your dog stay when you are not home |
| How many hours
will your dogs be home alone |
| Do you have a crate YesNo |
| Describe your feelings
about crating |
| Describe
where your dog will be when you are home |
| Where will
your dog sleep |
| Do you have a fenced in yard YesNo |
| Type of fence |
| Fence Height |
| If No fence how will
you potty and exercise your dog |
| How
many Adults in your home |
| How
many Children in your home |
| Please
list the ages and genders of the children |
| Are you expecting a ChildYesNo |
| Does anyone in the home have allergiesYesNo |
| Do you currently have any dogsYesNo |
| Please
list ALL of the Dogs currently in the home: Name, Age and Gender |
| Do you currently have any catsYesNo |
| Please
list ALL of the Cats currently in the home: Name, Age and Gender |
| Please
list any Other Pets in the home (other than dogs & cats) |
| Are ALL of your Dogs & Cats spayed and neuteredYesNo |
| If
one or all are not spayed or neutered please tell us which are not and
why not |
| Have
you had any other dogs in past currently not living with you and tell us
what happened to them |
| Are your dogs current on Heartworm PreventiveYesNo |
| If
Not on Heartworm Preventive please tell us why not |
| Are all of your pets current on their vaccinations YesNo |
| If
they are Not Current on their Vaccinations please tell us why not |
| Current
Vet Name |
| Current
Vet Address |
| Current
Vet Phone |
| Previous Vet Name |
| Previous Vet Phone |
| Your Occupation |
| Employers Name and Address |
| Employers Phone |
| Spouse Occupation |
| Spouse Employers Name |
| Spouse Employers Phone |
|
Please list the name, address and phone number (with area code) of One personal reference
|
|
Please list the name, address and phone number (with area code) of a second personal reference
|
|
Please list the name, address and phone number (with area code) of a third personal reference
|
| Are you willing to sign an Adoption Contract YesNo |
| Comments? Or more that you'd like us to know about your family? Feel free to write them here: |
|
By clicking the 'submit' button I certify that the above information is true. I further certify that I am financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am
able to meet these obligations. I understand that a home visit will be made prior to adoption. |