Atlantic County Canines Adoption Application
Applicant Information
Name of the dog or cat you are interested in:
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Your full name:
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Your age:
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Spouse name:
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Spouses age:
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Street Address:
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City, State, Zip
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Home Phone:
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-
Area Code
Phone Number
Cell Phone:
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-
Area Code
Phone Number
E-mail:
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Employer name and address:
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Please provide the name and phone number of your current and/or previous veterinarian or clinic:
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2 Character reference, Name, email and phone number:PLEASE ADD EACH PERSON'S EMAIL ADDRESS
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Current/Previous Pet Information
List any current pets you own or have owned in the past five years, and their ages. List the Veterinarian they used if different from current veterinarian. Are your pets spayed or neutered and if not please explain why.
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Have you ever given up a pet?
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Yes
No
If yes, what were the circumstances?
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Household Information
How many adults are in your household? Please list each adult name and age.Please list each adults phonenumber
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How many children in your household? Please list each Childs name and age.
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Are all members of your household in agreement with this adoption?
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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?
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Yes
No
Height and type of fence
New Pet Information
How many hours each day will your new pet be home alone?
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Are you willing to work through your new pet's issues, if any?
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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
Why do you want to adopt a dog or cat?
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Do you understand that a dog can be an 18 year commitment, and can cost $300 - $1,000 per year to care for?
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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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