Adoption Application

Adoption Application
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Place of Employment*
Job Title*
Name of dog you are interested in:*
Do you currently live in a:*

HouseApartmentCondoOther
Do you currently:*

OwnRent
How long have you lived at your current residence?*
Landlord's Name*
Landlord's Phone*
Please enter a valid phone number.
How many adults live in your home?*
How many children live in your home? (Please include ages. If none, write N/A.)*
Which of the following best describes your reasons for wanting this dog?*

CompanionGuard DogHuntingJoggingObedience TrainingWalking BuddyCouch Warmer
How many hours will the dog be alone each day?*
Where will the dog be kept when no one is home? Please provide necessary details.*
Where will the dog be kept at night? Please provide necessary details.*
Do you have a fenced-in yard?*

YesNo
How high is your fence?*
What type of fence is it?*
If you have other pets, are all of their vaccinations current?*

YesNo
Are they currently licensed?*

YesNo
Do you have an established veterinarian?*

YesNo
Veterinarian Name:*
Veterinarian Phone Number:*
Please enter a valid phone number.
Under what circumstances would you NOT keep this dog?*

Please list all the pets you have had in the last 7 years including current pets AND those you no longer own:

	Species	Breed	Age	Sex	Spayed/Neutered?	Owned how long?	Currently own? If not, please explain.
1.
2.
3.
4.
5.
6.

Please describe the temperament and activity level you are looking for in a dog:*

High EnergyOutdoorsy DogLap DogMellowAffectionateQuietGuard Dog
When it comes to relating to dogs, I tend to be more:*

Strict, demanding (dog must learn and follow all commands)Moderate, (encouraging of good behavior)Lenient (wishy-washy, easily coerced by the dog)
The noise/activity in my home is usually:*

HighMediumLow
I would prefer a dog that:*

Would enjoy walking with me on a leashWill exercise him/herself in our yardWould enjoy going to the dog parkWould run, jog, or hike with meRequires only enough exercise to do his/her business
Contractual Agreement
I, First Name* Last Name* understand and agree that Dogs Adoption Network makes no express or implied warranty, representation, or promise to the age, health, breed, habits, disposition, or safety of the animal. I hereby accept the animal as is, assume all risks and responsibilities associated with the ownership of the animal, including bites, and I hereby fully, and completely release, indemnify, and hold harmless Dogs Adoption Network, its directors, officers, volunteers, servants, and employees from any claim, cause of action or liability of any sort of nature, whether known or unknown, directly or indirectly arising out of, or in connection with the adoption, care or ownership, maintenance, temperament, or condition of the animal.
I, First Name* Last Name* agree in the case I cannot keep the animal: he/she will be re-homed via Dogs Adoption Network at an adoption event. The proceeds from the adoption will be kept by the Network for facilitating services. The animal will be kept in the care of current owner until adoption occurs. ALL MONIES DEPOSITED WITH DOGS ADOPTION NETWORK WILL BE CONSIDERED A DONATION TO THE RESCUE AND ARE NON-REFUNDABLE.
I, First Name* Last Name* acknowledge falsification of the above can result in me being denied an adoption of an animal.
I, First Name* Last Name* certify that the above information is true and correct to the best of my knowledge.
Adoption fee agreed upon by Dogs Adoption Network:*
Please sign to show that you agree to and acknowledge all of the above listed in the Contractual Agreement.*

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Email
example@example.com
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Adoption Application

Contractual Agreement