PACK Adoption Application New

PEOPLE FOR ANIMAL CARE & KINDNESS ADOPTION APPLICATION FORM

Name

Address

Street Address

Street Address Line 2

City State

Zip

Evening phone

Cell phone

Email

example@example.com

Employer

Spouse's Employer

Household members

Adults

# of Men

Children:

Ages

Are all your family members in favor of adopting a rescue dog?

Are you expecting a child or planning a family in the near future?

Is anyone in your household allergic to dogs?

Do you rent or own?

Type of home (house, apartment, condo/townhouse, trailer or duplex)

If you rent, do you have the landlord's permission to keep a dog?

Name and Phone number of your landlord

Do you plan to move in the near future?

How long have you lived at your current address?

Dog size limitations?

Would you be willing to allow us to visit your home prior to adoption?

INFORMATION ABOUT THE KIND OF DOG YOU WOULD LIKE TO ADOPT

Name of the specific dog you are interested in: Preferences if any: Gender: Age range: Would you consider a special needs dog? Why do you want to adopt a rescue dog; please identify all that apply (companionship, watch dog, company for current pet, a gift for someone)

Name of the specific dog you are interested in

Gender

Would you consider a special needs dog?

Age range

Other preference?

Why do you want to adopt a rescue dog; please identify all that apply (companionship, watch dog, company for current pet, a gift for someone)

Are you willing to return the dog if, due to unforeseen circumstances you no longer be able to keep the dog? If no, please explain

What size is your yard? (approx.)

Is it fully fenced?

Height & type of fence?

If not fenced, will you fence it before you adopt a dog?

Do you have a pool?

How many consecutive hours a day are you away from home for work, school, etc.?

Do you plan to keep the dog primarily indoors or out? Please explain

Where will the dog sleep?

What activities do you plan on participating in with your dog(s)?

Do you plan to use a crate for housebreaking, if needed, or while you are gone?

Where will your dog stay when you go on vacation?

Do you plan to take your new adopted dog to obedience class?

Who will be the primary caregiver for this dog?

What is the method of training your dog and correcting unwanted behavior?

Please let us know what makes you an ideal candidate to adopt a rescue dog

For what reasons would you return a dog back to us? (moving, not getting along with other pets, getting out of fence, children lost interest, too time consuming, allergies, medical problems, new baby, divorce, behavior problems, shedding, housebreaking problems, other reasons) Please identify all reasons that apply

List all pets you currently own:

Gender

Indoor/ Outdoor?

Age

Spayed/ Neutered?

Other pets, please list below

List any pets you have previously owned

If you've had dogs in the past, where are they now?

Have you ever given a dog up or had a dog for a brief period of time and it didn't work out? If yes, please explain the circumstances

If your pet develops a medical problem that becomes expensive, what would you do? (find another home for the dog, pay whatever it takes, give him to a rescue or shelter, other) Please identify all that apply.

List three references that can attest to your suitability as a pet owner and, more specifically, the owner of a rescue dog.

Name

Address

Phone number

Relationship

Name

Address

Phone number

Relationship

Name

Address

Phone number:

Relationship

Vet Reference (if you currently own pets or have in the recent past):

Address

Phone #

Name of veterinarian

Please let your veterinarian know that someone from PACK will be calling and that he/she has your permission to answer our questions.

I am over 18 years of age and information I have given above is true and complete.

Date

Applicant Signature

Clear