DOG Adoption Application

Name of dog you're interested in adopting: *
Personal Information
Name*

First nameLast name
Street Address*
City*
State*
Zip code*
Cell Phone Number:*
Please enter a valid phone number.
Email address*
example@example.com
Do you work:*

Full TimePart TimeFrom HomeRetiredOther
Please provide any comments or explanation of your work schedule here:*
Employer:*
Work Phone:
Please enter a valid phone number.
Personal Reference:

First NameLast Name
Personal Reference Phone Number:
Please enter a valid phone number.
Home Information
What type of home do you have?*

HouseApartmentTownhomeMobile HomeOther
If "other" please describe:
Do you rent or own?*

RentOwn
If renting, please provide the name and contact for the landlord or leasing office:

First NameLast Name
Phone Number for landlord/leasing office:
Please enter a valid phone number.
Is your property fenced?*

YesNo
If yes, please describe height and type of fence:
If no, what arrangements do you plan to make for exercise and bathroom duties?
Full names and ages of other adults (over 18 y/o) in the home:*
How many children live in your home?*
Ages of children?*
Where will the dog be when you are at home?*

Loose IndoorsCrateLoose Outdoors in a fenced yardGarageOther
If "other", please describe:
Where will the dog be when you are away from home?*

Loose IndoorsCrateLoose Outdoors in a fenced yardGarageOther
If "other", please describe:
Pet Ownership History
Do you currently own any other pets?*

YesNo
Please give name, breed, gender and age of each pet here:
Are all of your pets spayed or neutered?*

YesNo
If answer is NO, please explain why not:
Veterinarian Office: (***If you don't have any animals currently, you MUST provide the vet where your previous animals were seen***)*
Veterinarian's Address:
Veterinarian's phone: *
Type of Heartworm prevention you currently use, if any:*
Type of flea/tick prevention you currently use, if any:*
Please list all pets that you have owned in the past 8 years:*
If you no longer have them, please give details explaining what happened to them:*
If you have ever put one of your pets up for adoption or had one euthanized, please list names and provide details:*
I affirm that by submitting this application that ALL of the information on this application is true and complete, and that no one in the house where the pet will reside has ever been charged with or convicted of any type of animal cruelty.
Signature

Clear
Date

MonthDayYear
Date
Picture of driver's license, state or government issued ID:

Cancelof
Should be Empty:

Personal Information

Home Information

Pet Ownership History