DETAILS
Which dog are you interested in ?
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Are you interested in
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Fostering
Adopting
If the dog of your choice is not available, would you be interested in fostering or adopting another dog ?
I would be interested in fostering another dog
I would be interested in adopting another dog
I would not be interested in fostering or adopting another dog
PERSONAL INFORMATION
First name
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Last name
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Age
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Email
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Address
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Phone number
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When is a good time to call ?
Morning
Day time
Evening
Employment
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Employment of others in the household
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Personal references. Please provide name, phone number and email address of TWO personal references we may contact (neighbor, friend, co-worker)
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Household
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Own private house with yard
Rent private house with yard
Own apartment
Rent apartment
Other
If you chose "other", please explain
If you rent, please provide your landlord's name and phone number. We request this so that we can verify you are allowed to have a pet
Who will be responsible for the care of the dog ?
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Please list all pets who CURRENTLY live in your household (include name, type/breed, age, gender, fixed, how long owned, indoor or outdoor, cats declawed)
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Please list any pets you have owned in the past (include name, type/breed, age, gender, how long owned, what happened to pet)
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How do you plan to have the dog relieve itself ?
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What type of exercise and activities do you plan to have with the dog ?
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How many hours will the dog be alone each day ?
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Where will the dog be kept when you are not at home ?
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Where will the dog sleep ?
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Who will care for the dog when you are on vacation ?
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Would you like a trainer recommendation ?
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Yes
No
VETERINARIAN INFORMATION
If you currently have a pet, veterinary information below is required. Also, please advise your vet office to expect a call from one of our representatives and to release any information requested. If you do not currently have a pet, put "N/A" for each answer or provide a vet who has cared for a former pet
Your vet's name
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Vet's phone number
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Vet's address
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FOSTER / ADOPTION TERMS
I have read all of the above information carefully and have completed 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 lie is discovered after the adoption takes place, I understand that the Animal & Environment Association of Bethlehem reserves the right to cancel the adoption and reclaim the animal. If the application passes this review, I agree to a home visit or a video call on a mutually agreed date by a volunteer of the Animal & Environment Association. In addition, I understand that the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home and of other applications received for the animal. I understand that it is the organization's prerogative to decide which home is the most appropriate and that their decision is final.
By checking YES, you agree that if you are chosen to adopt the dog, an adoption contract will be issued, in the dog's best interest
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Yes
No
By checking YES, you agree that if you need to relinquish the dog during its life, you will contact the Animal & Environment Association of Bethlehem for its surrender
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Yes
No
By checking YES, you agree that the Animal & Environment Association of Bethlehem may contact the references listed above
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Yes
No
Signature
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Date
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Submit
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