Adoption Application V2

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

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

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number:*
Please enter a valid phone number.
Email:*
Are you 18 or older?*

YesNo
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Number:*
Please enter a valid phone number.
Do you Own or Rent?*

OwnRent
Rental Information:
Landlord Name:*
Landlord Phone:*
Please enter a valid phone number.
Important: Be sure to consult the lease concerning any pet deposit requirements.
What type of home do you reside in?*

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

YesNo
How many adults (18 or order) live in your residence?*
How many children live in your residence?
Leave blank if none
Age(s) of children:*
What pets 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
If yes, do you currently reside at the same residence?*

YesNo
Current veterinarian's name and phone:*
Have you ever given up to a shelter?*

YesNo
If yes, please explain:*
Is your yard fenced?*

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

YesNo
Is it fence and secured?*

YesNo
Should be Empty: