Animal Friends: Dog Adoption Application

Household Information
Do you:

OwnRentLive with parents
If you rent, please provide landlord's name and phone #:
Please list all the human members of your household:
For each person listed, please provide name, gender, and age.
What pets do you currently have?
For each pet listed, please provide the type of pet, breed, age, whether or not they are spayed/neutered, and your length of ownership.
Are your current pets up to date on their vaccines?

Veterinary Information
Who is/was your veterinarian?
For how long?
Vet Phone Number

Area CodePhone Number
Vet Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
*** If this is your first pet, we require that you find a veterinarian, set up an account, and schedule a new pet appointment in order for your application to be considered. ***
Are you financially prepared to give this dog BOTH routine and emergency medical care?
Would you object to a visit or call from us to see how you and your new dog are doing?
If yes, why?
Personal reference
Please provide name, phone number and relationship (no family or significant other).

My signature below certifies that the above information is true and correct.

Once this animal leaves AFNCWV property, you the adopter are solely responsible for that animal, its veterinary expenses, and its actions.
Type Name
Today's Date

MonthDayYear
Date
Signature

Clear
It is the right of AFNCWV to refuse adoption to anyone for any reason.
Should be Empty:

Animal Friends of North Central West Virginia