Adoption Application v1

Adoption Applicaiton
Important: There is a $25 chip transfer fee which will be charged by the veterinarian.
Date*

MonthDayYear
Desired Dog: Name*
Desired Dog: Breed
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Format: (000) 000-0000.
Email*
Are you 18 or older?*

YesNo
Do you Own or Rent?*

OwnRent
Landlord Name*
Landlord Phone*
Format: (000) 000-0000.
Important: Be sure to consult the lease contract concerning any pet deposit requirements.
What type of residence to you live in?*

HouseCondoApartmentOther
How long have you lived at your current address?*
Have all occupants of residence agreed to this adoption?*

YesNo
How many adults 18 or older live in your residence?*
How many children live in your residence?
Leave blank if none
Ages of children
What pet(s) currently live in your residence?
Leave blank if none. Otherwise list breed, gender and age of pet(s).
Has any pet contracted Parvo in the last 6 months?*

YesNo
Do you currently reside at the same residence?*

YesNo
Current veterinarian's name*
Phone*
Format: (000) 000-0000.
Have you ever given up a pet to a shelter?*

YesNo
Explain:
Is your yard fenced?*

YesNo
What type of material?*
How high is the fence?*
Do you have a swimming pool?*

YesNo
Is it fenced/secured?*

YesNo
Should be Empty:

Adoption Applicaiton