Form
Primary adopters full name
First Name
Last Name
Animal Applying For
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary adopters full name
First Name
Last Name
Is everyone in your home in agreement of owning a new pet?
Is anyone allergic in your home?
How many total people live in your home?
Do you have children living in the home? If yes, list ages.
Do you own or rent?
Own
Rent
If rent, name and phone number of landlord
How long have you lived at your current residence?
Current employer, name and phone number. How long have you been employed here?
Is anyone in your home allergic to animals?
Vet reference: ((name, address, phone number)) Please be sure to call your vet to release information to us when we call
1st ((non family)) personal reference: name and phone number - years known?
2nd ((non family)) personal reference: name and phone number - years known?
How many hours a day will your pet be left alone?
Do you have a fenced yard?
Do you currently have other animals in your home?: how many?(For each pet please list name, breed, age, gender, spayed or neutered, and up to date on vaccines, and up to date on preventatives like heartguard and flea and tick control)
What type of training do you plan to use for your new companion?:
Is there anything you’d like to tell us about yourself, your family, or your experience with dogs/breeds etc?
Please initial here for approval for us to verify home ownership.
Do you understand some puppies may need a few rounds of dewormer as we do not know their history often. We do our best to tackle all parasite problems before adoptions. Type “AGREE” below:
Do you understand that puppies and some shelter dogs may need some work on potty training and they can also go through a period of regression, even if fully trained in their foster home, in a new home. Are you in aggreement that you will work with them if they need work on a new routine and housebreaking pups? Type “agree” if you understand:
Do you understand breeds are guessed by our shelters and sometimes our vet if they need care? The breed is not a guarantee - meeting the pups in the best way to know if it’s your match! Type “AGREE” here if you understand this.
If this pet is currently not spayed or neutered due to age or appt date upon adoption, do you agree to have him/her spayed or neutered within 6 months of adoption date?((appt and surgery will be verified by us)): (Please type “Agree” if you’re in agreement)**
**All pets not spayed or neutered at adoption will have a $175 refundable deposit added to the adoption fee, this deposit will be returned upon completion of the surgery, along with a signed contract. Proof will be required. You can also use our clinic and we will use the $175 towards the cost of sterilization. Our clinic is located in Media, PA. If the pet has already been altered, type N/A.
Do you understand, if approved, acceptable forms of adoption donation are PayPal, Venmo, and cash app. If you do not have these, you can mail a money order to us with tracking, once received, adoption will be good to go. Type “I Agree” if you understand.
Submit
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