The Puppy Coalition Prospective Adopter Background Information

The Puppy Coalition Adoption Application
The Puppy Coalition (TPC) is an all-volunteer, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help TPC and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. TPC reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Applicant Information
Name of the dog you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip*
Home Phone:*
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
E-mail:*
Your Position and Employer:*
Character reference and phone number:*
Household Information
YesNoDon't Know
Who will be the pet's primary caregiver?*
HouseApartmentCondoMobile HomeOther
OwnRent
If rent, provide name and phone number of landlord:*
YesNoNA
Number of petsSize or weight restrictionsBreed restrictionsNone
YesNo
Height and type of fence*
Underground fenceKennelDog Run
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?*
YesNoNA
YesNo
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages*
How many of these pets are spayed/neutered?*
Where are these animals now?*
YesNo
If yes, what group?
YesNo
If yes, what were the circumstances?*
Please provide the name and phone number of your current and/or previous veterinarian or clinic, as well as the name and phone number of 3 references (not all family members):*
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
YesNo
YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
YesNo
YesNo
YesNo
YesNoNot sure
If yes, where?
YesNo
What circumstances would lead you to give up your new dog?*
If you had to give up your dog, what would you do?*
Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther websitePetSmartOther
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Name

First NameLast Name
Should be Empty:

The Puppy Coalition Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information