Atlantic County Canines Adoption Application
Applicant Information
Name of the dog you are interested in:
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Your full name:
*
Your age:
*
Street Address:
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City, State, Zip
*
Home Phone:
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-
Area Code
Phone Number
Cell Phone:
*
-
Area Code
Phone Number
E-mail:
*
Employer:
*
Character reference, Name, email and phone number:
*
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
*
Household Information
Are all members of your household in agreement with this adoption?
*
Yes
No
Don't Know
Do you live in a
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House
Apartment
Condo
Other
Do you own or rent?
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Own
Rent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?
Yes
No
Are there any restrictions from your landlord or subdivision?
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Number of pets
Size or weight restrictions
Breed restrictions
None
Do you have a fully fenced yard?
*
Yes
No
Height and type of fence
How many adults are in your household?
*
How many children are in your household?
*
If children, what are their ages?
*
Current/Previous Pet Information
List any current pets you own or have owned in the past five years, and their ages
*
Have you ever given up a pet?
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Yes
No
If yes, what were the circumstances?
*
New Pet Information
How many hours each day will your new pet be home alone?
*
Are you willing to work through your new pet's issues, if any?
*
Yes
No
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?
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Yes
No
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $1,000 per year to care for?
*
Yes
No
How did you find out about Atlantic County canines?
Adoptapet.com
Petfinder.com
Facebook
Friend/Family Member
Other website
PetSmart
Other
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Submit
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