Deez Louise Dogs
Application
Please complete the following information to the best of your knowledge
Your Name
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Email Address
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example@example.com
Address
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Address Line 2
Street Address Line 2
City
State / Province
Postal / Zip Code
State / Province
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Postal / Zip Code
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Phone Number
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Format: (000) 000-0000.
Secondary Phone Number
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Format: (000) 000-0000.
Animal(s) interested in adopting
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Would this be your first pet?
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What type of dwelling do you live in? Do you rent or own your home? If you rent provide your landlords name & phone number.
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How long have you lived in your current home?
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How many people live in your home?
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Do you have any children living in your home? If so what are the ages of the children.
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Are you employed? If so, where?
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Will your pet be inside, outside or both?
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Please list any animals you've had in the past five years (include names, type of pet. breed, age, gender, spayed/neutered status, indoor or outdoor pets)
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How many animals do you currently have?
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Who is your current Veterinarian (name/phone)? If you do not have a vet, who do you intend to use for this pet?
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Whose name is the account under at your veterinarian?
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Are you animals up to date on vaccines? If not, please explain why.
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Are your animals spayed/neutered?
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What are the names of your current pets?
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Reference #1: Please provide the name and phone number of a personal reference (who does not live with you).
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Reference #2: Please provide the name and phone number of a personal reference (who does not live with you).
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Have you ever been convicted or charged with animal cruelty or neglect If yes, when?
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What is it about this particular animal that draws your interest?
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Where and with whom will your pet spend most of his/her time?
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If your adopted animal has behavioral issues, how will you deal with those? (What if s/he claws your furniture? Gets on surfaces you do not wish them to jump on? Nips at your hands too hard? Chews on shoes, etc.?)
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Is there anything else you would like to let us know?
Adopter Signature
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Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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