Southampton Pet Hospital - Dog Adoption Application

Dog Adoption Application

The information you provide in this application will help us to ensure you and your future dog are a perfect match. Please be honest and descriptive in your responses.
Contact Information
Full Name: *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City Province

Postal Code
Phone Number: *
Email Address: *
example@example.com

Terms and Conditions
Information provided in this completed application may be shared with other staff members at the Southampton Pet Hospital, in an effort to make the best decision regarding the possible adoption of a dog. Your personal information will be kept confidential. The submission of this application does not confirm the adoption of this dog.

Vet care provided prior to adoption does not guarantee future health of this dog. Should you adopt this dog, his/her care is fully your responsibility. Please be advised that the dogs available for adoption are strays, and their origins are unknown. The adoption fee for a dog is $350.00. This fee is to be paid in full should you be accepted to adopt this dog. Adoption fees go entirely towards the necessary veterinary care prior to the adoption of this dog and support the care of both current and future strays.
I have read, understand, and acknowledge the above information provided to me by Southampton Pet Hospital. I claim all of the information that I have provided for this application to be true. *
Signature of applicant *

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Dog Adoption Application