Veteran Application Form

Veteran Application

Name of Veteran *

First Name Last Name

Email Address *

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

What branch of the service were you in? *

Service Status (Active, Veteran, Reservist)? *

Describe how having a companion dog would enrich your life: *

Are you able to complete your personal care needs? *

If you are a Veteran, can you provide a copy of your discharge papers? *

Do you currently have any pets?

Pet Names & Breed(s)

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Do you own or rent your home? *

Own Rent

Do you have a yard? *

Yes No

If "Yes" to the above, is it fenced? Please describe; fully fenced, partially fenced, height of fence.

If you Rent, what is your landlord's pet policy? *

May we visit your home to see where your pet will live? *

If you rent, please provide your landlord's information here: *

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter? *

Yes No

Are there other adults or children in the home? (If yes, please list names & ages) *

If you answered "Yes" to the above question, please provide detail:

If you adopt a pet, how many hours per day would the pet be alone? *

Will you crate your pet? *

If you have to leave town, either for an emergency or planned trip, where would your pet stay? *

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?: *

Please provide the names, emails, and contact numbers for 3 personal references: *

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment? *

Yes No

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to the Veteran Canine Connection (VCC) adoption process, will undergo a homecheck, and interview at the discretion of VCC.
By clicking the submit button, I understand VCC will check my references including veterinary and personal.
By clicking the submit button, I understand that if I no longer want or can no longer care for my adopted pet, I agree to notify VCC and allow VCC to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless VCC against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that VCC will disclose any of the pet's health or behavior issues known by the above named group before adoption is completed.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Veteran/Potential Adopter *