Adoption Application

Adoption Application

Contact Information

Full name(s):
______________________________________________________________

Address:______________________________________________________

______________________________________________________________

How long at this address:_______________________________________

Daytime Phone:_______________________________________________

Evening Phone:_______________________________________________

Best time to call:______________________________________________

Occupation:__________________________________________________

Email address:________________________________________________

Family & Housing

How many adults are there in your family?________________________

How many children (ages)?
______________________________________________________________

What type of home do you live in (single family, town home, apartment, farm, etc.)?
_____________________________________________________________________

Please describe your household: __ Active __ Noisy __ Quiet __ Average

If you rent, please provide landlord’s name and number:___________________

______________________________________________________________________

(by providing this information you are allowing us to contact your landlord)

Does anyone in the family have a known allergy to dogs?__________________

Is everyone in agreement with the decision to adopt a dog?________________

Do you have time to provide adequate love and attention?_________________

Other Pets

What other pets do you have (specify type and number)?
______________________________________________________________________

Are these pets up to date on vaccines?
__Yes __No

Are these pets spayed/neutered? If not..why?
__Yes __No:___________________________________________________________

Have you every surrendered a pet? If so, why?
__Yes __No:___________________________________________________________

Have you ever had a pet euthanized? If so, why?
__Yes __No:___________________________________________________________

Have you ever lost a pet to an accident?
__Yes __No
About the Dog You Wish to Adopt

Where will the dog spend the day? (describe)
________________________________________________________________________

Where will the dog spend the night? (describe)
________________________________________________________________________

Number of hours (average) dog will spend alone?__________________________

Who will have primary responsibility for this dog’s daily care?________________

Who will have financial responsibility for this dog?__________________________

What will happen to your dog if you go on a vacation or in an emergency?

_______________________________________________________________________

Do you agree to provide regular health care by a Licensed Veterinarian?
__ Yes __ No

Do you agree to provide grooming, as needed, by a professional groomer?
__ Yes __ No

Do you agree to consult with a professional dog trainer should the need arise?
__ Yes __ No

Do you agree to keep the dog as an indoor dog?
__Yes __No

When the dog goes out, how do you plan to supervise it? Fenced yard?

_______________________________________________________________________

Do you agree to contact us if you can no longer keep this dog?
__Yes __No

How did you find us?____________________________________________________

Would you be interested in fostering? __Yes __No __Tell me more

Personal References
(by providing this information you are allowing us to contact your reference)
Please list someone who is familiar with both you and your pets.

Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):

Veterinary Reference
(by providing us with this information you are allowing us to call your vet)
Practice Name:
Veterinarian’s Name:
Address:
Phone:

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

______________________________________________​_________
Signature(s)​ Date

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