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*
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.)*
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*
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*
yesno
ActiveNoisyQuietAverage
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, *
yesno
yesno
yesno
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:*
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?*
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?*
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