ALL PAWS CONSIDERED, INC.

Marietta, GA 30068
Phone: 770-640-5550

EMail: nlsherman@earthlink.net or jenjay22@bellsouth.net

ADOPTION APPLICATION; PLEASE COMPLETE THE FOLLOWING:

IDENTIFICATION INFORMATION

Name:

Age: Occupation:

Street Address:

City: State: Zip: County:

E-mail:

Home Phone: Work Phone: Cell phone:

Name of Dog/Breed in which you are interested:

Are you willing for an APC., INC. Inc. representative to visit your home by appointment? Yes No

Check any of the following reasons for adopting this dog:

Family pet Child's pet Watch dog Companion Hunting dog

Guard dog for business Companion for another pet Gift

Other, specify:

Please specify where you live:

Mobile Home: Apartment: House: Condo:

Other, specify:

Apartment complex name:

Do you rent or own? Rent Own

If you rent, do you have your landlord's permission to own a dog? Yes No

Your landlord's phone number: Amount of pet deposit:

HOUSEHOLD

Do you or anyone in your household currently have any serious health problems? If so, please describe:

Does anyone in the household smoke? Yes No

Adults in household and relationships (Please specify)

Number of children in house including ages

Do any family members have allergies? Yes No

If yes, please specify:

Will this dog be a surprise for any family members? Yes No

If yes, for whom?

Current pets, type, gender and ages:

Where does your current dog(s) stay when home alone during the day?

Where does your current dog(s) sleep at night?

PLANNING FOR YOUR PET

How many times in the past five years have you moved?

If you move, will your pet go with you? Yes No

Would you ever consider moving somewhere that does not allow pets? Yes No

Do you foresee any major changes in your life in the next 15 years (average lifespan of a dog) such as marriage, children, health challenges due to age, or going away to college? If yes, please explain.

Can you provide a permanent home for this dog for 10-15 years? Yes No

Who will be responsible for the daily care and feeding of your pet?

Do you have a fully fenced yard with no fence gaps? Yes No

If yes, how high and what kind?

If no, would you consider fencing all or part of it as a condition of adopting a dog? Yes No

Do you have a doggie door? Yes No

If no, and if it would work better, would you consider installing one? Yes No

Are you willing to keep a collar and ID tag at all times on all your pets, including your new dog?

Yes No

Where will the new dog sleep at night?

Will this new pet be allowed on the furniture? Yes No

How many hours will the dog be alone on a typical day?

Where will your dog stay when home alone during the day?

Outside in fenced area Outside in dog pen Outside on chain or tie-out Basement

Garage Run of house Inside one room Crate

Other, specify:

Under what circumstances do you believe it is OK to leave a dog outside alone and unsupervised in a fenced area?

Under what circumstances would you give up a pet? Indicate choices:

Moving New baby Not getting along with other pets Divorce Escaping fence Behavior problems Children lost interest Gets too big Too time consuming Shedding AllergiesProblem with housebreaking Medical problems Aggressive behavior

Other, specify:

If you are unable to keep your dog for any reason at any time, are you willing to return the dog to APC, Inc.? Yes No

If you date or marry someone who does not like or want your pets, what would you do?

PET HISTORY

Do any of your current or did any of your past pets live primarily outdoors? Yes No

If yes, please describe pet:

Were all previous pets spayed and neutered? Yes No

How many dogs have you owned in the past?

If any, please describe what happened to each: (old age, given away, hit by car, etc..)

Have you ever had a serious problem with a previous dog? If so, please describe

Have you always kept an ID tag (other than a rabies tag) bearing your phone number on all your pets?

Yes No

Have you ever given up a dog or had a dog for a brief period of time and it didn't work out? If so, please explain.

Have you ever looked at or applied for a pet with another rescue group? If so, how long ago and did you adopt?

HEALTH AWARENESS

Do you know about heartworm disease and how to prevent it? Yes No

Is your current dog or was your previous dog on heartworm prevention medication? Yes No

If yes, how often did you give the heartworm medication?

What brand did you use?

How do you plan to prevent fleas and ticks?

Are you aware of Frontline or Advantage? Yes No

Has a dog or puppy died on your premises in the last six months of parvo, distemper or unknown causes? Yes No

If your pet later develops a medical problem that becomes expensive, what would you do?

Find another home Pay whatever it takes Put to sleep Give to rescue group Shelter

Other:

If your pet later develops a frequent urination problem at the age of 12 and is incontinent when left alone, what would you do?

Have him put to sleep Baby gate in uncarpeted area Install doggie door

Other, specify:

If you are considering a long-haired breed, how often and who would groom the dog?

Do it Yourself Groomer How often?

What type of food and brand will you buy

What do you expect annual pet care to cost, including vet, medication, and heartworm prevention?

What is your veterinarian's name and telephone number?

Please list the names, addresses and phone numbers of two references:

Thank you for taking the time to complete this application.