K9 TRAINING AT HOMEWARD BOUND ADOPTION APPLICATION
Adopter Information
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
Age
*
ID/ Driver's License #:
Employment
Are you currently (check all that apply):
*
Employed Full Time
Employed Part Time
Unemployed
Retired
Student
Other: _________________
Line of work:
*
Job Title
*
Employer:
*
Family Information
Please list the names, age, and relation to you of ALL people living in the household.
Name
Age
relation
1
2
3
4
5
6
7
8
Home Information
Do you rent or own your home?
*
Own
Rent
If you Rent, what if your Landlord's name
Landlord's phone #:
Please enter a valid phone number.
Home Description:
*
House
Condo / Townhouse
Apartment
Mobile
Travel Trailer
Do you have a fenced in yard:
*
Yes
No
If Yes, what kind of fence and how high?
Adoption Information:
What is the name of the pet you wish to adopt?
*
What is the reason you wish to adopt this animal?
*
Love animals, want to help an animal in need.
Companionship
My children will learn how to be responsible and care for another living thing
Guard dog for property
Rodent Control for home, garage, barn or other building
Feel sorry for the animal
A gift for someone
If a gift for someone, for who?
Other Reason:
Veterinary Care
Are you willing to provide regular vet care for your new pet?
*
Yes
No
Do you agree to have regular wellness exams, including vaccinations?
*
Yes
No
Can you afford veterinary care up to $500 a year for your new pet?
*
Yes
No
Who is your current or past veterinanrian: Name/ Phone # :
*
Do you give K9 Training at Homeward Bound permission to speak with your Veterinarian to obtain information on the health care of your current/past pets:
*
Yes
No
Please list all the pets you currently own or have owned in the past
Name
Pet Type
Age
Breed
Where did you get he/she
Spayed/ Neutered?
Living / Deceased
Age at time of passing
1
2
3
4
5
Do your current pets wear ID tags?
*
Yes
No
Are your current pets microchipped?
*
Yes
No
Are your current pets' vaccinations up to date?
*
Yes
No,
If No, Why?
Are your current pets on heartworm prevention:
*
Yes
No
If Yes, Which prevention do you use?
Which hours during the day will your pet routinely be home alone. For example, if everyone is at work between 8 ‐ 4 on Monday, youwould write 8 ‐ 4 in the Monday box.
Time Frame
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Do you plan on allowing your pet inside the home?
*
Yes
No
When inside, how do you plan to keep your pet? (Select all that apply)
*
Free roam inside
Inside a closed room
confined in a crate
When/if outside, how do you plan to keep your pet? (Select all that apply)
*
NA, indoor only
Garage/ patio area
Invidible fence
Fenced yard
Outside dog run
Leash/ regular walks
Tie out
Other
Where will your pet be kept during the day?
*
Where will your pet be kept at night?
*
Training and Behavior
How do you plan to handle undesirable behavior such as chewing, accidents in the house, spraying, scratching furniture, excessive crying/barking, getting onto counter tops?
*
Responsibility
Who will be primarily responsible for the care of the pet? How old is this person?
*
Have you ever had to surrender a pet ?
*
Yes
NO
If you had to give up a pet, why?
*
How long will you keep the pet you are planning to adopt? If you were to move in the future, what will you do with the animal you plan to adopt?
*
If your animal(s) were to survive you, who or what (such as a will) would ensure that they would not be taken to the shelter?
*
If you can no longer provide your pet a home do you agree to return he or she to K9 Training at Homeward Bound Inc.?
*
Yes
No
Adopter Name (Printed)
*
Signature
*
Date:
*
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