Adoption Form
Canines and Company
Name of Dog You Wish to Adopt
Name
First Name
Last Name
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long you have lived at this address
How you heard about Canines and Company
Current Occupation
Name of Employer
Does your job require extensive travel?
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Current Household Information
What type of housing do you live in?
Apartment
Condo
Single House
Mobile Home
Other
If Other, Please Explain:
Describe Your Household (busy, quiet, noisy, etc.)
Do you own or rent your home? If you live in a condo or in a rental property, please provide your property management's contact information so we can verify pet policy.
How many adults (over 18) including yourself are in your home?
Are there minors (under 18) living in the home?
Yes
No
Do any members of your household have a dog allergy?
Yes
No
Do you currently have pets? If so, what species of pet(s) do you have? What is the breed, age and sex of your pet(s)?
Have your pet(s) been spayed/neutered? (If not, please explain.)
Are your pets current on their vaccinations?
Yes
No
What Veterinary clinic do you currently use? Please provide a phone number and city.
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Pet History
What pets have you had in the past?
What happened to the pets you no longer have?
Have you ever given a pet to a shelter? If yes, please explain.
Have you ever had a pet euthanized? If yes, please explain.
What Veterinary clinic do you currently use? Please provide a phone number and city.
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Adoption Questions
Please describe in detail the type of dog you are looking for.
How much time would you say you have to play with/exercise and train your new pet?
Where will your new pet live?
Is someone home during the day? If so, who?
What is your current tolerance level for minor destruction, such as chewing, scratching furniture, knocking items off shelves, and/or house training accidents?
Around how many hours each day will the dog be left alone? Please explain.
Where will the dog be kept during the day? At night?
Do you plan to crate train this dog?
Yes
No
Why would you like to add a new dog to your home? (companion, companion for other pet, house pet, watch dog, guard dog, hunting, personal protection, etc.) Please explain.
If you move, will you take your dog with you?
Are you willing to take responsibility for this dog for the next 10 to 15 years? The commitment of adopting a dog is very important to us. Please take this decision very seriously and take the time to decide if you are willing to keep this dog in your home for the duration of its life.
Do you plan on continuing this dog's training in order to make this dog a good member of the family? If yes, what are your expectations for time commitment to training?
Have you ever adopted from Canines & Company before? If yes, please provide the name of the dog adopted.
Would you consider adopting a dog with special needs? (medical or behavioral)
What size dog are you looking for?
What age range of dog are you looking for?
Please describe activities you would like your new dog to be involved in.
Please describe the qualities you are looking for in a dog
Are you comfortable with a post-adoption home visit from a Canines & Company staff member?
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References
Reference Name
First Name
Last Name
Relationship to Reference
Reference Email
example@example.com
Reference Phone Number
-
Area Code
Phone Number
Reference Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference Name
First Name
Last Name
Relationship to Reference
Reference Email
example@example.com
Reference Phone Number
-
Area Code
Phone Number
Reference Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
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