CANINE ADOPTION APPLICATION

1
Staff Only - Landlord Approval
Approved
Denied
2
Staff Only - Yard Check
Approved
Denied
3
Staff Only - Application Approved
Approved
Denied
4
Are you adopting from Pawtriotic Pet Hotel?* This field is required.
YESNO
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Please Upload a photo of your ID* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Dog ID#Enter the Dog ID# found on the animal's kennel card or collar.
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Are you willing and able to make a LIFETIME commitment to the care of this pet (15+ years)?* This field is required.
Yes
No
8
Name* This field is required.
First Name
Last Name
9
Address* This field is required.
Street Address
Apartment/Suite # (If Applicable)
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Primary/ Cell Phone:* This field is required.
11
Secondary/ Home Phone:
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Email Address:* This field is required.
example@example.com
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SOURCE OF INCOME* This field is required.
Employed
Retired
Other
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Name* This field is required.
15
Phone:* This field is required.
16
I live in a:* This field is required.
House
Apartment
Condo
Mobile Home
Other
17
I Own, Rent/Lease, or Other* This field is required.
Own
Rent/Lease*
Other
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Landlord Name:* This field is required.
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Landlord Phone:* This field is required.
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I understand a yard inspection may be required as part of the adoption process. PLEASE INITIAL:* This field is required.
21
Do you have any children/grandchildren in your home?* This field is required.
Yes
No
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Ages of children/grandchildren:* This field is required.
23
Does anyone in the household have allergies to animals? Please check all that apply* This field is required.
Dogs
Cats
Other
None
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Do you have any current pets on property that YOU own?* This field is required.
YESNO
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Name* This field is required.
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Breed* This field is required.
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Age* This field is required.
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Sex* This field is required.
Male
Female
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Sterilized?* This field is required.Spay/Neutered
Yes
No
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Where is your pet kept?* This field is required.
Indoors
Outdoors
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How long has this pet been in your care?* This field is required.
32
Is your pet licensed?* This field is required.
Yes
No
I don't know
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Do you have another pet to enter?* This field is required.
YESNO
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Name* This field is required.
35
Breed* This field is required.
36
Age* This field is required.
37
Sex* This field is required.
Male
Female
38
Sterilized?* This field is required.Spay/Neutered
Yes
No
39
Where is your pet kept?* This field is required.
Indoors
Outdoors
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How long has this pet been in your care?* This field is required.
41
Is your pet licensed?* This field is required.
Yes
No
I don't know
42
Do you have another pet to enter?* This field is required.
YESNO
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Name* This field is required.
44
Breed* This field is required.
45
Age* This field is required.
46
Sex* This field is required.
Male
Female
47
Sterilized?* This field is required.
Yes
No
48
Where is your pet kept?* This field is required.
Indoors
Outdoors
49
How long has this pet been in your care?* This field is required.
50
Is your pet licensed?* This field is required.
Yes
No
I don't know
51
Do you have another pet to enter?* This field is required.
YESNO
52
Name* This field is required.
53
Breed* This field is required.
54
Age* This field is required.
55
Sex* This field is required.
Male
Female
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Sterilized?* This field is required.Spay/Neutered
Yes
No
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Where is your pet kept?* This field is required.
Indoors
Outdoors
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How long has this pet been in your care?* This field is required.
59
Is your pet licensed?* This field is required.
Yes
No
I don't know
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Do you have more pets on property that you own?* This field is required.
YESNO
61
Describe any remaining pets on property you own.
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Are there other animals on property that are not owned by you?* This field is required.
YESNO
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Owner's NamePet #1
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Pet's NamePet #1
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BreedPet #1
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AgePet #1
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SexPet #1
Male
Female
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Sterilized?Spay/Neutered, Pet #1
Yes
No
Unsure
69
How long has pet been at residence?Pet #1
70
Is this pet licensed?Pet #1
Yes
No
N/A
I don't know
71
Is there another pet on property?Pet #2
YESNO
72
Owner's NamePet #2
73
Pet's NamePet #2
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BreedPet #2
75
AgePet #2
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SexPet #2
Male
Female
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Sterilized?Spay/Neutered, Pet #2
Yes
No
78
How long has pet been at residence?Pet #2
79
Is this pet licensed?Pet #2
Yes
No
I don't know
80
Is there another pet on property?Pet #3
YESNO
81
Owner's NamePet #3
82
Pet's NamePet #3
83
BreedPet #3
84
AgePet #3
85
SexPet #3
Male
Female
86
Sterilized?Spay/Neutered, Pet #3
Yes
No
87
How long has pet been at residence?Pet #3
88
Is this pet licensed?Pet #3
Yes
No
I don't know
89
Is there another pet on property?Pet #4
YESNO
90
Owner's NamePet #4
91
Pet's NamePet #4
92
BreedPet #4
93
AgePet #4
94
SexPet #4
Male
Female
95
Sterilized?Spay/Neutered, Pet #4
Yes
No
96
How long has pet been at residence?Pet #4
97
Is this pet licensed?Pet #4
Yes
No
I don't know
98
Are there more pets on property?
YESNO
99
Describe any remaining animals on property.
100
Where will the dog be kept during the day?* This field is required.Select all that apply.
Inside Home
Outside Home
Garage
Kennel
Yard
Other
101
Where will the dog be kept during the night?* This field is required.Select all that apply.
Inside Home
Outside Home
Garage
Kennel
Other
102
Where will the dog be kept when you travel? (friend, relative, neighbor, etc.)* This field is required.
103
Length of time dog will be left alone.* This field is required.
Less than 1 hour
1-4 hours
4-8 hours
Over 8 hours
104
Is your yard fenced?* This field is required.
No Yard
No
Yes
105
How high is the fence? (in feet)* This field is required.
106
Material (chain link, wood, brick, etc.)* This field is required.
107
What form of shade is in your yard?* This field is required.Select all that apply.
Trees
Covered Patio
Dog House
None
Other
108
Do you have a pool?* This field is required.Select all that apply.
In Ground
Above Ground
Fenced from dog area
Covered
No Pool
109
Do you plan on moving in the next 3 to 6 months?* This field is required.
Yes
No
110
Location moving to:
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Can you cover any illness that may occur after adoption? (including, but not limited to; Parvo, URI's, Kennel Cough, Worms, ETC.)* This field is required.
Yes
No
112
Do you have time and/or funds for basic, behavioral, or destructive training that may be needed?* This field is required.
Yes
No
113
Do you have the time to allow the dog 3 weeks to 3 months to fully adjust and be comfortable in their new home?* This field is required.
Yes
No
114
By adopting this dog, I am aware of the licensing laws and ordinances enforced within the jurisdiction of Animal Friends of the Valleys and within the State of California.Please initial
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Are you adopting a puppy 6 months of age or younger?* This field is required.
Yes
No
116
PLEASE ASK YOURSELF THE FOLLOWING QUESTIONS:

1. Can I afford to treat an illness?

2. How much can I spend on veterinary care?

3. If your puppy becomes ill and passes away, will the family be able to cope with the loss?

Parvo is the most prevalent in the Spring and Fall when many puppies are born. The risk at this time is the greatest. All puppies, including purebreds, are at risk of this disease. Animal Friends of the Valleys does its best to place only healthy puppies for adoption.
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PLEASE INITIAL:* This field is required.I have read and understand the information in the previous section.
118
All dogs and cats are given their 1st set of vaccines. It is highly recommended to follow up with a booster within 30 days from the initial vaccine given, if needed.

Low cost vaccinations are available at our Spay/Neuter Clinic. An adoption counselor can provide you with a clinic flyer that includes the hours, directions, and pricing.
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APPLICANT SIGNATURE:* This field is required.By signing, I hereby release Animal Friends of the the Valleys from liability from any injury or incident incurred to myself and all members of my party. I certify the information on my application is true to the best of my knowledge.
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DATE:* This field is required.
Date
Month
Day
Year
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Animal Friends of the Valleys reserves the right to reject any application.

If you are at the shelter for your adoption, Please pull a number at the front reception and we will call you as soon as we can! See you soon!
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