New Adoption Application 3/22/20

Today's Date:*

Date

Name of dog you're interested in adopting:*

Where did you see our adoptable dog? *

Your Name*

First NameLast Name

Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Subdivision or Complex name ?*

Your Email*

example@example.com

Your Phone Number*

Area CodePhone Number

How many adults are residing in the residence? *

Ages of current adults in the residence?*

Age of applicant(s)*

*Our Policy Requires Us to Visit Your Home*

Do you OWN or RENT*

OwnRent

If you rent what is your Landlord's policy on pets?*

*Our Policy Requires Us to Call Your Landlord*

Landlord's Name:*

Landlord's Phone Number*

Area CodePhone Number

Is there a deposit fee for pets?*

YesNo

Any weight restriction for pets?*

YesNo

If YES, what is maximum weight?*

Any breed restrictions?*

YesNo

If YES, what breeds are prohibited?*

Do you have a completely fenced secure yard?*

YesNo

If yes, how high?*

Type*

(Chain link/Privacy)

Does your complex have a designated fenced in dog area/park?

YesNo

Are there children residing in the home*

YesNo

If YES, what are their ages?*

Do you have children/grandchildren that frequent your home/periodically visit on weekends or holidays? *

If yes, what are their ages?*

Do you CURRENTLY have any other Pets?*

YesNo

Please list the name, breed, and gender of each pet currently in your home: This is a required field if something does not apply type N/A or 0, X for numerical fields*

	Name	Breed	M/F	Temperament	Current on vaccinations Rabies & Distemper ?	On Heartworm Preventative?	Spayed or Neutered?	Age	Weight of animal
1
2
3
4

If not spayed/neutered or current on Rabies & Distemper vaccinations, is there a medical reason given by a vet?*

If not on heartworm prevention is there a medical reason given by a vet?

Have you had any other pets in the LAST 5 YEARS?*

YesNo

Please list the name, breed, and gender of each pet that were in your home in the last 5 years:*

	Name	Breed	M/F	Reason you no longer have the dog	If had to rehome, please give reason	Age of dog
1
2
3
4
5

*Our Policy Requires Us to Call Your Veterinarian*

Please contact the vet's and give them permission to speak with us.

Primary Veterinarian Name:*

Vet Phone Number:*

Area CodePhone Number

If you have used different veterinarian's for preventative care or specialty care, please list all veterinarian's information. (I.E. vaccination clinics) Vet's name:

Vet's phone number

Area CodePhone Number

Vet's name

Phone Number

Area CodePhone Number

Vet comments:

When no one is home, where will your dog stay?*

How many hours a day will the dog spend alone?*

Where will your dog sleep at night?*

Are you prepared to spend $150-$300 per year in veterinary fees for routine vaccinations and preventative medications? (Annual vaccinations, Heartworm and Flea/Tick Preventative, etc.)*

YesNo

Are you financially able to secure medical care if your dog gets sick or injured?*

YesNo

Briefly describe your past experiences with pets:

In case you experience a life change (I.E. a move, a divorce, a new baby, etc), how will this affect the dog? What arrangements will be made if there is a family/medical emergency?*

Do you understand that adopting a pet is a commitment for the animal's entire lifetime?*

YesNo

Are you willing to accept that responsibility?*

YesNo

*Our Policy Requires Us to Call Your Personal References* Please do not list yourself, or anyone else in your household. We will not process application without references. Thank you.

Name*

Phone Number*

Area CodePhone Number

Name*

Phone Number*

Area CodePhone Number

Have you reviewed Needy Paws Rescue adoption information/policy? Have you read the dog's full bio and understand the requirements of the dog? If not please re-visit the dog's bio.*

YesNo

Comments:

Do you agree to the above terms? By clicking yes this verifies that you are at least 21 years of age or older and reside with in an hour of the St. Louis area.*

YesNo

Adoption Application: If there is a required field that does not apply put an "X" or "N/A"