Adoption Application

1

Name of the dog interested in:* This field is required.

2

Your Name:* This field is required.

First Name

Last Name

3

Your Age:* This field is required.

4

Address:* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

Phone Number:* This field is required.

Area Code

Phone Number

6

Alternate Phone Number:

Area Code

Phone Number

7

Email:* This field is required.

example@example.com

8

Employer:* This field is required.If Retired, write N/A.

9

Your line of work:* This field is required.If retired, any hobbies or N/A

10

Gender and ages of all adults in your household?* This field is required.

11

If children, what are their gender and ages?* This field is required.

12

Are all members of your household in agreement with this adoption?* This field is required.

YESNO

13

Who will be the pet's primary caregiver?* This field is required.

14

Do you (or anyone in your household) have any health conditions, physical limitations, or other special needs that we should consider in finding the right dog for you? (Please explain.)* This field is required.

15

Are you aware that dogs want to be family companions; therefore, they need attention and human companionship, and may develop behavioral problems if left alone for long periods of time?* This field is required.

16

Do you rent or own?* This field is required.

Rent

Own

17

How long have you lived at your current address?* This field is required.

18

If you rent, do you have your landlord's permission to have a pet?* This field is required.

YESNO

19

Are there any breed or weight restrictions for pets?* This field is required.

20

May we contact your landlord?* This field is required.

YESNO

21

Landlord's Name, Phone Number and Email* This field is required.

22

Do you have a yard?* This field is required.

YESNO

23

Is it fully fenced?* This field is required.

YESNO

24

If yes, height and type of fence?* This field is required.

25

Can a dog fit through the fence?* This field is required.

YESNO

26

Do you have a pool?* This field is required.

YESNO

27

Will you allow us to do a home check?* This field is required.

YESNO

28

List type/breed, gender, weight and ages of any animals that live in your home:* This field is required.

29

How many of these pets are spayed/neutered?* This field is required.

30

Are they up to date on vaccines, flea and heart worm preventative?* This field is required.

YESNO

31

Have you owned dogs in the past?* This field is required.

YESNO

32

If so, what happened to them?* This field is required.

33

Have you ever given up a pet?* This field is required.

34

Name and phone number of your current and/or previous vet or clinic:* This field is required.

35

Do you understand the importance of dental cleaning on heart health?* This field is required.

YESNO

36

If you have or had small dogs, did they receive dental treatments? If yes, where did they have dentals (name of Veterinarian and phone number) and how frequently or how many times? * This field is required.

37

Will you be getting insurance for your new pet? * This field is required.

38

Please explain what you would do if an emergency occurred and your adopted dog needs medical care, that was more than you could afford?* This field is required.

39

What other characteristics or traits are you looking for?* This field is required.

40

Will you provide house training?* This field is required.

YESNO

41

Will you provide obedience training?* This field is required.

YESNO

42

Where will the dog spend the day?* This field is required.

43

How many hours a day will the dog spend alone?* This field is required.

44

How many hours a day will the dog spend outside?* This field is required.

45

How will you supervise the dog's outdoor activity?* This field is required.

46

What will be the dog's sleeping arrangements?* This field is required.

47

In case of an emergency, who can take care of your dog if you're unable to be at home?* This field is required.

48

What length of time will you allow your new pet to adjust to his/her new home?* This field is required.

49

Are you willing to work through your new pet's issues, if any?* This field is required.

YESNO

50

Adopting a dog is a commitment that could last 10-18 years and cost at least $300-$500 per year. Are you ready and willing to make this commitment?* This field is required.

YESNO

51

What circumstances would lead you to give up your new dog?* This field is required.

52

If you had to give up your dog, what would you do with him/her?* This field is required.