Adoption Application
Adoption Application
NOTE: You must be over 21 to submit an application.
Date
/
MM
/
DD
YYYY
Name of dog you are applying for:
CONTACT INFORMATION
Name
First
Last
Address 1
Address 2
City
State
Zip code
Daytime phone
Evening phone
Home email address
Work email address
Spouse's name
First
Last
HOUSEHOLD INFORMATION
Please indicate how many adults (over 18) live in your household:
Please indicate how many children (under 18) live in your household:
What are their ages?
Are all members of the household in agreement about adopting a dog?
Yes
No
Do you own or rent your home?
Own
Rent
If rent, please give your landlord's name and phone number so we may verify that you are allowed to have pets:
Please describe your home. Apartment, single family detached, duplex, etc.
Do you have a backyard?
Yes
No
If so, is it fenced in?
Yes
No
What height is the fence? Please note that a fenced-in yard is NOT a requirement for adoption unless specifically stated in the dog's description.
EXPERIENCE Please note that experience with dogs is NOT a requirement for adoption unless specifically stated in the dog's description.
Have you ever lived with a dog before?
Yes
No
If yes, please describe your experience(s) and a brief history of what happened to the dog(s).
If your last dog has past away, please state dog's name and date deceased.
Has your dog ever produced puppies?
Yes
No
Have you ever given a dog up to a shelter or rescue organization?
Yes
No
Do you currently have any animal companions at home?
Yes
No
If yes, please indicate type of animal and how many:
CARE OF THE DOG
How do you plan to have your new dog relieve itself?
Do all adults work full time?
Yes
No
How many hours each day will your new dog be alone?
How many hours each day will you spend time with your dog?
Where will your new dog be kept when it is alone?
Where will your new dog sleep?
What sort of training do you plan on providing the dog?
REFERENCES
Please provide your veterinarian's name and phone number (if you have one). We will call them as a reference. If you do not have a veterinarian, please provide the name and number of a non-family member that we may contact.
Please realize that dogs need vet care throughout their lives, including yearly boosters, heartworm and flea/tick preventive meds, etc. If you cannot afford a donation, can you afford the appropriate vet care? Please consider this before adopting. Bottom of Form
