Adoption Application

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / 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)? *

Yes No

Applicant Date of Birth *

Month Day Year

Employer *

Job Title *

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

Do you own your home or rent? *

Own Rent

Do you live in a: *

Single family home Duplex Townhouse Mobile home Condominium Apartment

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

Are there any restrictions or covenants where you live? *

Yes No

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. *

Yes No

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

Yes No

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. *

Yes No

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? *

Yes No

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? *

Yes No

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? *

Yes No

Do you plan on tail docking/ear cropping? *

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

Yes No

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? *

Yes No

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? *

Yes No

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? *

Yes No

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

Yes No

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? *

Yes No

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

Do you have other pets? If so, please list their breed 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 breeds 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? *

Yes No

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): *

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: