Dog Adoption Application

Serenity Animal Hospital Dog Adoption Application
Date*

MonthDayYear
Date
Name of pet(s) that you're interested in meeting
Name*

First NameLast Name
Birth Date*

MonthDayYear
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Best time to call*
I am interested in a:*

Puppy 0-6mYoung Dog 6 months-2yearsAdult Dog 2-7Senior Dog 7+
What type of home do you live in? (house, apartment, condo, townhome, etc.)*
Do you*

rentownlive with parentsOther
Landlords Name and number - if applicable, please let them know we may be calling.If you own your home please type n/a*
Current Employment Information*

Employed Full timeEmployed Part timeUnemployedRetiredStudentOther
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?*

yesno
Please describe your household*

ActiveNoisyQuietAverage
My Yard - choose all that apply*

has a privacy fencehas an invisible fencehas an indoor area with pee pads/newspaperhas a chain link fencehas an outdoor runhas a stationary tie-outhas a dog houseOther
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 - If you do not call them ahead of time, it will delay our response time.*
If you already have current copies of your pets medical records, or vaccination information, please upload it. This saves a lot of time when reviewing your application.

Browse Files

Cancelof
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)

yesno
Are your pet(s) spayed or neutered?

yesno
Are your pets given heartworm preventative year round?*

yesno
Are your pets given flea preventative year round?*

yesno
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 petDog that needs medicationDog that needs groomingMellow/easy going petdog that will run/jog with meshy dogdog that needs trainingvery affectionate/attention seeking petpet 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?*

Couch potatoYard ExerciseShort walksLong, Vigorous walksHiking/JoggingOther
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*

biting/nippingbarkingmedical needsmarking/can't be house brokenfighting with current petscounter surfing/beggingchewing/destroying possessionsfence jumping (over 4ft)diggingseparation anxietydivorce or death of spouse/partnerchanged my mind about having a petkids leave home/won't be caring for petchange in healthnew babynew partner doesn't like the petnew job/movingloss of incomeNONE 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. *

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Serenity Animal Hospital Dog Adoption Application