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.Format: (000) 000-0000.
Email address*
example@example.com
Full TimePart TimeFrom HomeRetiredOther
Please provide any comments or explanation of your work schedule here:*
Employer:*
Work Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference:

First NameLast Name
Personal Reference Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Home Information
HouseApartmentTownhomeMobile HomeOther
If "other" please describe:
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.Format: (000) 000-0000.
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?*
Loose IndoorsCrateLoose Outdoors in a fenced yardGarageOther
If "other", please describe:
Loose IndoorsCrateLoose Outdoors in a fenced yardGarageOther
If "other", please describe:
Pet Ownership History
YesNo
Please give name, breed, gender and age of each pet here:
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: *
Format: (000) 000-0000.
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:*
By signing below, I affirm that all information provided in this application is true, complete, and accurate. I understand that providing false or misleading information is grounds for denial of this application or revocation of an adoption. I affirm that no one in the household where the adopted dog will reside has ever been charged with or convicted of any form of animal cruelty.

I give permission for R.A.D.A.R. to verify all information provided, including contacting my landlord, veterinarian, and personal references. I also give permission for a virtual or in‑person home check as part of the adoption process.

If approved, I agree to keep the adopted dog as an indoor family pet and to provide appropriate care, supervision, and a safe living environment at all times.

My signature below indicates my understanding and agreement to all of the above terms.
Signature
Date

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

Cancelof
Should be Empty:

Personal Information

Home Information

Pet Ownership History