Adoption Application
Dog(s) applied for
*
Name
*
First Name
Last Name
Your Age
*
Date
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Home Phone
-
Area Code
Phone Number
Cell Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Do you live in a ?
House
Condo
Apartment
Townhome
Do you Rent/Own ?
Rent
Own
Your Occupation
*
Your Work Schedule/hours
*
Spouse/Partner Occupation
Spouse Partner Work Schedule/hours
Times you will be home
*
Aproximate hours dog will be left alone per day?
*
Names of all persons living in household, their relationship to you and ages: (including children)
IN THE EVENT OF DEATH OR IMCAPACITY TO TAKE CARE OF: THE DOG WHOME WOULD YOU TRANSFER THE DOG TO? (Name/Phone)
*
WE WILL ALWAYS TAKE A DOG BACK BUT NEED NAME OFINDIVIDUAL WHO WOULD BE RESPONSIBLE TO EITHER KEEP THE DOG OR CONTACT US TO RELINQUISH IT BACK TO.
*
Does EVERYONE in your family want to adopt this dog?
Yes
No
Please list 3 personal references and their relationship to you: Name./Relationship/Phone
*
Pets you already have: Breed: Age: Sex: Spayed/Neutered: How long have you had it
Have you ever had a dog?
*
Yes
No
Have any of your dog(s) ever had any puppies?
*
Yes
No
Current Companion Animals you have (type/breed/age/sex how long have you had it?) Example: Dog/Shepherd/5 yrs/Male-since he was 8 weeks old)
Do you have any cats? If yes how many?
Has any member of your family ever experienced animal related allergies? if so please explain
Have you ever trained a dog in obedience classes?
Yes
No
Your family veterinarians Name and Phone number
Who would be responsible for the care of the dog?
*
What is your primary reason for adopting this dog?
*
Where would your dog sleep? Inside / outside? if Outside Where? OR Where ?
*
Do you have a swimming pool?
*
Yes
No
If "Yes" d you have safety fencing around it? and how high?
If sleeping outdoors Where?
*
Kennel/dog run
doghouse
Patio
Yard
Garage
N/A
Other
Is your yard fenced?
*
Yes
No
Height of your fencing if you checked "YES" above
Do you have a doggy door
*
Yes
No
When you are at home the dog would be where?
*
Always indoors
Mostly indoors
Always outdoors
Mostly outdoors
When you are NOT at home where would the dog be left
*
If the dog were outside at all what space would be available for your dog?
*
Fenced Yard
Patio
Dog run
balcony
Unfenced yard
Other
Do you feel obedience training makes a dog a better companion?
Yes
No
Do you travel a great deal?
*
Yes
No
If "Yes" for how long at a time?
What provisions would be made for yor dog if you had to move to a place that did not allow dogs or pets?
*
Under what circumstances would you not keep your dog.. please explain:
*
If your dog became destructive to your home, what would you do? Please explain:
*
The dog may live 15 years PLUS, what would you do with your dog if you could no longer care for your dog? Please explain:
*
Is there anything else you would like to tell us about yourself or your home environment?
*
All information I have provided in this application is true and correct. If any of the information changes, I will advise promplty? SIGNATURE
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: