Serenity Animal Hospital Dog Adoption Application
Name of pet(s) that you're interested in meeting
Street Address Line 2
State / Province
Postal / Zip Code
Best time to call
I am interested in a:
Young Dog 6 months-2years
Adult Dog 2-7
Senior Dog 7+
What type of home do you live in? (house, apartment, condo, townhome, etc.)
Landlords Name and number - if applicable, please let them know we may be calling.
live with parents
Current Employment Information
Employed Full time
Employed Part time
If employed, please list your employer, job title/line of work and length of time employed there
How many adults live in your home?
How many children live in your home?
Age of children in the home
Does anyone in the home have a known allergy to dogs or cats?
Please describe your household
My Yard - choose all that apply
has a privacy fence
has an invisible fence
has an indoor area with pee pads/newspaper
has a chain link fence
has an outdoor run
has a stationary tie-out
has a dog house
Current Veterinary Hospital Name & Number. Please call the ahead of time to let them know that it's ok to release information to Serenity Animal Hospital
Please list your current &past pets: name, breed, age,
Are your pet(s) current on ALL vaccinations? (including DHLPCA, Rabies, Bordetella, Fecal Testing, Heartworm Test, and Canine Influenza)
Are your pet(s) spayed or neutered?
Are your pets given heartworm preventative year round?
Are your pets given flea preventative year round?
If you answered no to either of the last FOUR questions, please explain why
If you have every relinquished custody of a pet before, please explain why:
I would be willing to adopt a: (select all that apply)
Very high energy,active pet
Dog that needs medication
Dog that needs grooming
Mellow/easy going pet
dog that will run/jog with me
dog that needs training
very affectionate/attention seeking pet
pet that needs little to no grooming
Where will your dog spend most of the day?
Number of hours (average) that the dog will be home alone?
Who will have primary responsibility for this pet's daily care?
Who will have financial responsibility for this pet?
What will happen to the pet if you go on vacation?
If you move in the future, what will you do with the pet you are planning to adopt?
Will you allow the dog on furniture/beds?
Will the dog have run of the house?
Are you aware that veterinary care could cost up to $600 per year, without any serious illness?
Do you agree to provide regular, yearly health care by a licensed Veterinarian?
Do you agree to keep this pet as an indoor dog?
Do you agree to contact Serenity if you can no longer keep this pet?
What is your preferred level of exercise with a dog?
Long, Vigorous walks
Do you plan to take your new dog to training?
If no, please explain why
What will you do if the pet is destructive while left alone?
When the dog goes outside, how do you plan to supervise it?
What method will you use to discipline your dog?
What would cause you to return your potential dog to us in the future? check all that apply
marking/can't be house broken
fighting with current pets
fence jumping (over 4ft)
divorce or death of spouse/partner
changed my mind about having a pet
kids leave home/won't be caring for pet
change in health
new partner doesn't like the pet
loss of income
NONE OF THE ABOVE
Personal References- please list the Name, Number & Relationship for 2 references
All of the information I have given is true and complete. This pet will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examinations, vaccinations, heartworm and flea preventative from a licensed Veterinarian.
Should be Empty: