Dog /Puppy Adoption Form
Name of the dog/puppy you want to adopt
Adopter's Name
First Name
Last Name
Co-Adopter's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Adopter's Email
example@example.com
Co-Adopter's Email
example@example.com
Phone Number
-
Area Code
Phone Number
Phone Type
Names and ages of all permanent residents of your home (children and adults) *Must list ages of all*
Employer (Name, address, phone number)
Are you a student? If so, please list school you are attending
Will this be your first dog?
Current pets in your home
Have they been spayed/neutered?
Are they current on vaccinations?
Have you ever turned an animal into a shelter? If yes, please explain.
Have you ever had a pet euthanized? If yes, please explain.
Veterinarian (Name, address, phone number) *please give permission to your vet to speak with us for reference and verification purposes)
Where are your current pets kept?
Have you had other animals as pets? If yes, please list.
If you have pets, will they adjust to a new dog/puppy entering the home?
Where will the dog/puppy sleep? (be specific)
I/ We live in a
Do you own/rent this property?
Landlord's Name/Phone Number
Do you have a yard?
Is your yard fenced? If yes, height/type of fencing?
Do you have a dog door/gate? If so, please explain.
Do you work outside of the home?
How many hours a day are you away from the home? How many hours a day will the dog/puppy be left alone? Please explain.
Have you discussed adoption with all members of your household?
Where will the dog/puppy be kept? Please be specific.
Are there times the dog will be tied up? If yes, please explain.
Would you be willing and able to exercise the dog/puppy on a regular basis? Please explain.
If you go away on vacation, who will take care of the dog?
Are you willing to have a representative of Helpers 4 Shelters come to see where the dog will be living?
What provisions will you make for the dog should you become unable to care for him/her?
How much are you willing to spend on medical bills for the dog?
$250-$300
$500 -$1000
$1500-$3000
Whatever it takes
What would you do of the vet bills went over that amount?
What activity level do you prefer?
couch potato
medium energy
high energy
Please check all that apply. I want to adopt this dog..
as a companion
playmate for my other dog(s)
protection
family pet
Gift for family/friend
Please check all that apply. My adopted dog/puppy will...
be crated if best for the dog/puppy
be kept indoors most of the time
be left outside while we are away
be trained off leash
attend formal training
will interact with people regularly
have free rieign of the house while we are away
be included in all family functions
go on frequent walks
attend doggie daycare
kept on a lead/cable in the yard
take frequent care rides/trips with us
Please check all that apply. What behaviors would deter you from adopting this dog?
Growling
Barking
Fear of men, women, children
Mouthing
Jumping
Rough play
food allergies
chewing
counter surfing
Doesn't like other dogs
special diet
special medical needs
I will do whatever it takes to help this dog become part of the family
What would cause you to return a dog?
What do you feel is a reasonable amount of time for a dog/puppy to adjust to your home and family life?
How do you plan to integrate this dog/puppy into your family?
Do you have or plan to get pet insurance?
What type of food do you plan to feed your dog/puppy?
Please provide a personal reference NOT related to or living with you. (Name,phone number)
Do you have any additional question, comments or concerns regarding this dog/puppy?
How did you hear about us?
I certify that the information entered on this application is true. Enter your name and date:
Applicant's signature / Date
Co-applicants signature/date
Submit
Should be Empty: