Adoption Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Alternate Phone Number*

Please enter a valid phone number.

Where did you hear about Adopt-A-Dog?*

Would you like to be added to the Adopt-A-Dog mailing list to receive updates about the shelter (typically once a month)?*

YesNo

Applicant Date of Birth*

MonthDayYear

Employer*

Job Title*

Please list all members of your household, including ages and occupations:*

Do you own your home or rent?*

OwnRent

Do you live in a:*

If you rent, please provide the name and phone number of your landlord:*

Are there any restrictions or covenants where you live?*

YesNo

If yes, please list/explain:*

Please list the name and breed of the animal(s) you are interested in adopting.*

Please explain why you think this pet is a good fit for you:*

Why do you want to adopt a dog?*

What do you think are the most important responsibilities in owing a dog?*

Do you have any upcoming plans (vacation, business trip, etc.) that would prevent you from adopting within the next 5-7 days? If so, please explain.

1. I agree that Adopt-A-Dog shall not be held responsible for any liability for your pet once he/she has been adopted.*

YesNo

2. I agree that my pet will not be used in any illegal activities.*

YesNo

3. I agree that my pet will be kept as a house pet and will not be used for breeding, scientific purposes, or animal fighting.*

YesNo

Who will be responsible for the care of your pet?*

How would you describe the activity level in your household?*

Where will your pet stay during the day/at night?*

Will anyone be home during the day?*

YesNo

How many hours will the dog be left unattended?*

Who will be responsible for feeding the dog and taking him/her outside?*

Are you willing to keep a collar with a tag bearing your name and phone number on your dog at all times?*

YesNo

What will you do with the dog when you travel?*

What will you do with the dog if you move/change housing?*

Will your pet have a dog walker/pet sitter?*

Are there areas of the home where your pet is not allowed?*

How will your pet exercise?*

Would you walk/exercise a dog on or off-leash, or both?*

Is your yard fenced in? If so, please describe what type of fence and the height.*

If not, why not?*

Have you ever bred dogs?*

YesNo

Do you plan on tail docking/ear cropping?*

Are you willing to take the time to work on housebreaking issues should the need arise?*

YesNo

Do you understand and accept that changing a dogs environment may cause the dog to have accidents, especially in the early days of the adoption?*

YesNo

The average life span of a dog is 12-15 years - are you willing to make a commitment to this dog for the rest of his/her life?*

YesNo

Please list any circumstance in which you would no longer keep your pet.*

Please explain what you would do if you could no longer keep your pet.*

Does anyone in your household have allergies to animals?*

If someone in your family develops allergies, what would you do?*

If, for any reason you are unable to keep your dog do you agree to notify Adopt-A-Dog immediately?*

YesNo

If you are unable to keep your dog, do you agree to return him/her to Adopt-A-Dog without hesitation?

YesNo

Are you prepared to pay for emergencies or accidents for your pet?*

How do you plan to train your pet?*

Would you consider obedience training for your pet?*

YesNo

If a behavioral problem arises, what steps will you take to work on it?*

Do you have other pets? If so, please list their name(s), breed(s) and age:*

Are your current pets spayed/neutered? If not, please explain why:*

Have you had pets in the past? If so, please list their name(s), breed(s) and how long you had them:*

If you no longer have these pets, please explain why:*

Have you ever given away an animal for any reason?*

YesNo

What do you consider a good/valid reason for giving up a dog?*

Please supply the name and phone number of your current or most recent veterinarian - be sure to indicate what name the pets medical records may be filed under. (Also, please call your veterinarian in advance to give them permission to speak with us, otherwise the application process may be delayed.):*

Please list TWO personal references including phone numbers - these should be people who know you especially with respect to your interaction with animals:*

Please list any concerns or final questions here:

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that Adopt-A-Dog has the right to annul the adoption and reclaim the dog.

I give Adopt-A-Dog permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by an Adopt-A-Dog representative before an adoption decision is made.

Furthermore, I understand and accept that the adoption decision depends upon many factors, including – but not limited to – the compatibility of the family and home to the individual dog and other applications received on the dog. I understand and accept that Adopt-A-Dog will decide which home is most appropriate for the individual dog, and therefore I will not take issue with the decision. Unless otherwise indicated by Adopt-A-Dog, I may be considered for another dog.

Signature*

Clear

Adoption Application

Please fill out ALL INQUIRIES to the best of your ability - incomplete applications will not be considered

Pets I am Interested In

Liability and Waivers:

Your Pet's Lifestyle

Would You Give Up Your Pet If…:

Your Pet Experience:

References: