Form

PLEASE BE AWARE THAT FILLING OUT THIS APPLICATION MAY TAKE ANYWHERE FROM

10 MINUTES to 30 MINUTES OR MORE DEPENDING ON HOW DETAILED YOUR ANSWERS ARE.

PLEASE SET ASIDE THE RIGHT AMOUNT OF TIME NECESSARY TO COMPLETE THE

APPLICATION BECAUSE IF YOU NAVIGATE AWAY YOU WILL LOSE ALL YOUR WORK.
Part I

Personal Information
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Work Phone Number (Daily) *

- Area Code Phone Number
Evening Phone Number

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
E-mail *
Age
Occupation *
Average hours out of the home per day *
May we contact you at work? *

Yes No
Do you have any allergies? *

Yes No
If yes, please list your allergies:
Are you expecting a child or planning a family in the near future? *

Yes No In the near future

Part II

Family Information
Partners Full Name

First Name Last Name
Age
Occupation
Hours away from home
Number of Adults (+18 years old) *
Relation to you
Age
Occupation
Average hours out of the home per day
Relation to you
Age
Occupation
Average hours out of the home per day
Relation to you
Age
Occupation
Average hours out of the home per day
Number of children (-18 years old) *
Ages
Does everyone living in the houseold agree to adopt a dog? *

Yes No
Does anyone have allergies? *

Yes No
If yes, please list who and what they are allergic to:
Who:
Allergies
Who:
Allergies
Who:
Allergies
Who:
Allergies

Part IV

Pet History
Please list all pets you've owned in the PAST.
Name
Breed
Sex
Fixed
19XX - 20XX
What happened?
Have you ever given up any animal? *

Yes No
If yes, please explain the circumstances:
Have you ever euthanized any animal? *

Yes No
If yes, please explain the circumstances:

Part V

Current Pets
Please list all pets CURRENTLY living in your home.
Name
Breed
Gender
Fixed
Age
Name
Breed
Gender
Fixed
Age
Name
Breed
Gender
Fixed
Age
Name
Breed
Gender
Fixed
Age
Important character information
How are you planning to introduce your new pet to your current pet?

Part VII

Important Information AND Signature
We are a no kill rescue and we take our work very seriously. Please, when filling out this application and submitting your request to become an adoptive family for one of these Beautiful Souls , remember that you are adoption a sentient being. Dogs are lively, energetic, happy-go-lucky animals. They trust you, are loyal to you, will love you, and look up to you.

... HOWEVER... your new addition to your family may:

be destructive, disobey, be restless, need of rehabilitation, be clingy, shy fearfull, and more.

PLEASE MAKE SURE ADOPTING IS RIGHT FOR YOU AND THAT YOU ARE COMMITTED 100%.

Commitment means, if you start seeing problems arising in his/her behavious, seek expertise. Contact us and we will recommend many tips for you to try. Dogs need love, affection, playtime, quiet time, and axercise. It is imperative that you pay attention to your newest best friend appropriately and accordingly in order to see change in unwanted behaviour. There are many books to help you become more comfortable with dog behaviours as well as many online tools. We will always be there for you if the adoption goes through. Please remember that whatever problems you are having, you may contact us and we will do whatever we can to ensure that your family is at peace, content and remains together.

Some dogs nibble, don't like cats, or other dogs for that matter. Dogs are not allowed in all apartment buildings, but many do allow pets. It just takes effort to find the right places. Do you have hat it takes? Dogs may destroy, chew valuable materials and must eat, play, drink, and sleep. They also unfortunately get sick... Dogs live up to 15 years of age and older.

These beautiful souls cannot be bounced around and around, so please understand; this is a life you are caring for and loving. Treat them as though you have adopted a child and never allow them to be discarded again.

A broken soul looking for security, respect, values, discipline, and LOVE. Are you in this until the end, to see it throuh and adopt a Bell'Anima (Beautiful Soul)?
If you understand all of these traits of a dog, are you willing to work through all of these problems? *
Tell us why you are 100% committed: *
Adoption Fees
- Purebred Puppies – $535.00
- Purebred Adult Dogs – $485.00
- Small Breed Dogs – $485.00
- Mixed Puppies – $435.00
- Mixed Adult Dogs – $385.00
- Senior Dogs or Comapssionate Adoptions- $75.00
Puppies (less than 8 months)
Adults (8+ months)
Seniors (7+ years)
SIGNATURE *
POSITION IN THE HOUSEHOLD *
SIGNATURE
POSITION IN THE HOUSEHOLD
SIGNATURE
POSITION IN THE HOUSEHOLD
SIGNATURE
POSITION IN THE HOUSEHOLD

Part VIII

References
Please provide at least two references attesting that you are fit to be a good adoptive family. References should not be people who live under the same roof as you.
Vet Reference
Clinics Name *
Veterinarian *

First Name Last Name
Phone Number *

- Area Code Phone Number
E-mail

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reference #1
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Day Phone Number *

- Area Code Phone Number
Evening Phone Number

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
E-mail
Relationshipt to potential Adopter *
Reference #2
Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Day Phone Number

- Area Code Phone Number
Evening Phone Number

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
E-mail
Relationshipt to potential Adopter
Reference #3
Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Day Phone Number

- Area Code Phone Number
Evening Phone Number

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
E-mail
Relationshipt to potential Adopter

Part IX

Questions, Comments, Concerns
Questions, comments, or concerns
Thank you for taking the time to fill out our Adoption Application and being interested in our rescue. Your kindness and generousity are so greatly appreciated.

We hope that we can find you the perfect new addition to your family.
Should be Empty:

Part I

Part II

Part III

Part IV

Part V

Part VI

Part VII

Part VIII

Part IX