Dog Adoption Application

Dog Adoption Application

INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED
Are you interested in a particular dog? If so, who?
Applicant 1 *If you have a spouse/partner that lives with you, the Applicant 2 information is required.*

First NameLast Name
Age of Applicant 1
Applicant 2

First NameLast Name
Age of Applicant 2
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number for Applicant 1
Please enter a valid phone number.
Phone Number for Applicant 2
Please enter a valid phone number.
Email Address for Applicant 1
example@example.com
Email Address for Applicant 2
example@example.com
Employer for Applicant 1
Employer for Applicant 2
For Military Applicants, provide Branch and Command
Type of Residence

Rental or Military HousingOwned
If you rent, provide the name and phone number of owner/landlord/property management company.
How long have you lived in this residence?
How long have you lived in Hawaii?
Who else lives at this residence? Provide ages and their relationship to you, including children.
What cats or dogs do you currently own? Are they sterilized and current on shots? Please list.
What cats and dogs have you owned previously as an adult and where are they now? (not family pets growing up)
Where will the dog live?

InsideOutsideBoth
If both, please explain:
What happens if you must leave suddenly or travel? Who will care for the dog?
What are some situations in which you feel you might surrender this dog? What other pets have you surrendered in the past and why?
If you plan to move out of state, will you take your pets with you? Have you researched the costs to leave the island with a pet?
What will you do if your dog show destructive behavior? (digging, chewing, jumping, tearing up plants/furniture or running off)?
Dogs often live longer than 10 years. Are you committed to providing a forever home for this dog?
By initialing the following items and and signing below I agree that:

I will NOT surrender or rehome this dog. I will contact PDP and return the dog to PDP.
I will not crop the ears or dock the tail of this dog – an inhumane and unnecessary practice opposed by the American Veterinary Medical Association.
I am 21 years of age or older and I am able to provide proof upon request.
If I have omitted or provided misleading or inaccurate information, my application will be denied and any adoption rescinded.
Unsterilized pets: In the event that I adopt an unsterilized pet, I understand that I am required to take the pet to its scheduled appointment and the adoption is not finalized until the pet has been sterilized. I also understand that I will be required to return the pet to Poi Dogs & Popoki if I do not take the pet to its sterilization appointment.
I grant permission to Poi Dogs & Popoki to use photographs and/or video of me in newsletters, online, and in other communications related to the mission of Poi Dogs & Popoki.
Applicant 1 Signature:

Clear
Applicant 2 Signature:

Clear
How did you hear about Poi Dogs & Popoki

Social MediaFrom shopping at PetSmartWord of mouthPreviously adopted from PDPPetFinder
Approval Status
Date of adoption

MonthDayYear
Name of dog adopted
Microchip number
Breed, gender, and approximate age/dob
Dog photo or clinical screenshot

Cancelof
Coordinator Notes
Should be Empty: