Dog Adoption Application

Are you interested in a particular dog? If so, who?

Applicant 1

First Name Last Name

Age of Applicant 1

Applicant 2

First Name Last Name

Age of Applicant 2

Address

Street Address

Street Address Line 2

City State

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 Housing Owned

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?

Inside Outside Both

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 4 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If I have omitted or provided misleading or inaccurate information, my application will be denied and any adoption rescinded.

Applicant 1 Signature:

Clear

Applicant 2 Signature:

Clear

How did you hear about Poi Dogs & Popoki

Social Media From shopping at PetSmart Word of mouth Previously adopted from PDP

Approval Status

Name of dog adopted

Date of adoption