Dog Adoption Application & Contract
Dog of Interest
Name, description or preferences
Applicant Information
Applicant's Legal Name
*
First and Last Name
Mailing Address (Include City, State & Postal/Zip Code)
If different from above street address
Street Address (Include City, State & Postal/Zip Code)
*
Address where Dog will reside
Phone Number
*
-
Area Code
Phone Number
Applicant's Email
Home & Household Information
Please verify with your Landlord or Homeowners' Insurance Company that the breed you are interested in is permitted on property. Breeds such as pit bulls or bulldogs may not be.
Home Information (What type of home will the dog live in?)
*
House
Mobile Home
Condo/Townhouse
Apartment
Other
Home Ownership Information
*
I Own my Home
I Rent my Home
Other
Home Owner/Landlord's Name (If you are not the Home Owner)
Home Owner/ Landlord's Phone an/or E-mail (If you are not the Home Owner)
The Home has the following (Please select all that apply):
*
A Fenced Yard
No Fenced Yard
No Yard
An Outside Kennel
Locking Gates on Yard and/or Kennel Door
A Dog Door
Other
If there is no fenced yard how will you exercise the dog?
If the yard is not fenced who will walk the dog and how often will you take the dog out?
Please list below all the people your dog will be living with (including yourself):
Name & Age (Self)
*
Name, Age & Relationship
If child; Name is not required
Name, Age & Relationship
If child; Name is not required
Name, Age & Relationship
If child; Name is not required
List additional household members below (Name, Age & Relationship)
If child; Name is not required
Did your entire family agree on the adoption of this one dog?
*
Yes
No
Will the whole family share in the care of this dog?
*
Yes
No
Is there any member of your household who is allergic to dogs?
*
Yes
No
Possibly
Are there any children that visit your home frequently?
*
Yes
No
Possibly
Ages (if applicable)
*
Non-Applicable
Newborn - 6 months
6 months - 1 year
1-2 years
3-5 years
5-10 years
10-14 years
14-17 years
General Care
Do you want this dog to be:
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Inside pet only
Outside pet only
Both an Inside and Outside Pet (Depending on the weather)
Where will the dog be kept during the day?
*
Where will the dog be kept at night?
*
Where will the dog be kept when you are not home?
*
How many hours during the average day will your dog be without a human?
*
Are you planning to move within the next 6 months?
*
Yes
No
What will happen to the dog if you move unexpectedly?
*
What will you do if your new dog doesn't like other dogs?
*
What will happen to the dog if your new residence doesn't allow pets/pit bulls?
*
What will happen to the dog if you go on vacation or in case of an emergency?
*
Emergency Contact Information (in case dog is found an you are unreachable)
*
Emergency Contact Name and Phone
If you have a truck how will your dog be transported?
Please tell us why you would like to adopt a dog:
*
Do you have any other pets living with you now?
*
Yes
No
Plan to adopt more
Household Pets
Pet #1 (Dog, Cat, Bird, Etc)
Breed
Sex & Spayed/Neutered
Age
Pet #2 (Dog, Cat, Bird, Etc)
Breed
Sex & Spayed/Neutered
Age
Pet #3 (Dog, Cat, Bird, Etc)
Breed
Sex & Spayed/Neutered
Age
List additional pets below (Breed, Sex/Spayed or Neutered & Age)
Have you owned pets in the past?
*
Yes
No
List Past Pets below (Type/Dog, Cat, Bird, Etc & Breed)
Where are your Past Pets now?
Health & Behavior
Veterinary Name or Office
*
Veterinary Phone and/or Email Address
*
How often do you feel a dog should see a veterinarian?
*
Do you feel you are financially capable of paying for routine veterinary care?
*
Yes
No
What will you feed your new dog?
What kind of behavior do you find unacceptable?
If the dog has problems with behavior what will you do about it?
Would you euthanize a dog for Aggression towards other animals (dogs, cats, livestock)
*
Yes
No
Other
Additional Information
Have you ever been charged and/or convicted of child or animal abuse or neglect
*
Yes
No
Pending
If you have been charged or charges are pending, please describe the circumstances below:
Please check with your officer to ensure you are permitted dogs/pit bulls.
Additional Information for consideration (if any)
References
Reference #1 Name:
*
Reference #1 Phone or Email:
*
Cell Phone Prefered
Reference #1 Relationship to Applicant:
Reference #2 Name:
*
Reference #2 Phone or Email:
*
Cell Phone Prefered
Reference #2 Relationship to Applicant:
Reference #3 Name:
*
Reference #3 Phone or Email:
*
Cell Phone Prefered
Reference #3 Relationship to Applicant:
Adoption Contract/Terms of Acceptance
(Upon Adoption Approval & Transfer of Ownership)
Acknowledgment of Applicant/Signer
*
✔I/We hereby agree to care for this dog humanely, (including providing adequate food, water, shelter and attention).,
✔I/We agree that said dog shall be maintained in an adequate enclosed area or on leash at all times. Dog shall not be allowed to roam at will while off your property
✔I/We agree to have dog neutered/spayed (if applicable).,
✔I/We agree to have dog vaccinated annually with necessary inoculations (DHLP-P) and vaccinated against Rabies, as local ordinances requires.,
✔I/We agree to provide essential veterinary care, as needed.,
✔If said dog becomes lost or stolen, I/We agree to notify the "seller" immediately.,
✔If, at any time, I/We are unable or unwilling to care for this dog, I/We agree to contact and return said dog to the "seller" or a representative.,
✔I/We also agree not to sell, trade, dispose of or euthanize said dog (unless recommended by a veterinarian in the best interest of said dog),
✔I/We agree that said dog shall not be used for medical or any other experimental purposes.,
✔I/We agree that said dog will not be sold or given to a pet store, supplier or wholesaler, family member, friend or anyone else
✔I/We agree that said dog will not be used for any illegal purposes.,
✔I/We agree that said dog will NEVER be fought in any way.,
✔I/We certify that we do not live in a home or area where "Pit Bulls" are banned.,
✔I/We agree to notify the "seller" within 10 days of any change of address or phone number.,
✔I/We understand that the "seller" makes no guarantees or warranties regarding the health or temperament of this dog.
General Acknowledgement
(Upon Adoption Approval & Transfer of Ownership)
Acknowledgment of Applicant/Signer
*
✔I/We have read and understand the above terms and conditions of adoption.
✔I/We will keep the dog described herein as a family pet.
✔I/We understand this is a binding contract, enforceable by civil law.
✔I/We understand a breech of contract may result in confiscation of the dog and a fine ,punishable of up to $2500.00.
By signing below, I warrant the truthfulness of the information provided & certify that all information is true. I understand that false information may result in nullifying this adoption at any time. Electronic Signature
*
Type Legal Name:
Date:
Submit
Should be Empty: