 |
ADOPTION APPLICATION
Please fill the application out in full. Incomplete applications will be deleted. |
|
ADOPTION APPLICATION
Please fill the application out in full. Incomplete applications will be deleted. |
To move between questions you MUST use the TAB key or the MOUSE. The enter key will automatically act as the send button.
| Today's Date |
| First Name |
| Last Name |
| Address |
| City |
| State |
| Zip |
| Work Phone |
| Home Phone |
| Cell Phone |
| Email
Required |
| Are you interested in a specific dog? YesNo |
| If
'yes' 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 roles 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 roles you would want your dog to fill in your home: |
| We recommend to facilitate the bonding process each new dog should attend an obedience class. |
| Would an obedience class in your area be something that you would be willing to do? YesNo |
|
If you checked "No" please explain why not:
|
| Residence:
|
| If you rent please give the Owner's Name & Phone number below |
| Owner's Name |
| Owner's 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 stay when you ARE home? |
| Where will your dog sleep at night? |
| 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 live in the home |
| How
many Children in your home (please include weekend visitations) |
| Please
list the ages and genders of the children |
| Are you expecting a Child? YesNo |
| Does anyone in the home have allergies to pets? YesNo |
| Do you currently have any dogsYesNo |
| Please
list ALL of the Dogs currently in the home: Name, Age,
Breed 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, (Birds, rabbits, snakes, etc.) |
| 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 for example; planning to breed, too young, etc. |
| Have
you had any other dogs? Please give us
their name 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 Many Vets require your authorization to release information. We do call your veterinarian to verify records. Please contact your Vet giving your permission for us to discuss shot records. If we call your vet and permission has not been granted, we will stop there and delete your application. |
| Current
Vet Address |
| Current
Vet Phone |
| If you have been with your "Current" Vet for less than 1 year or the "Current" Vet has not seen your pet for shots yet, please fill in the name of your previous vet. |
| Previous Vet Name If you had a pet, please give the name and phone number of your previous pet's Vet. |
| Previous Vet Phone |
|
Your Occupation |
| Employers Name
|
| Employers Address |
| Spouse Occupation |
| Spouse Employers Name |
| Spouse Employers Phone |
|
Please list the name, address and phone number (with area code) of a 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: |
|
Have you missed any of the questions? Vet &/or Previous vet is very important! If the application is not filled out in full, it will be deleted. 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. |