Adoption Application

Adoption Application

Please answer all questions. You may use N/A if the question doesn't apply.
What is the name of the dog you're interested in?*
Applicant's Name*
Co Applicant's Name (if applicable)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
Phone Number*
Please enter a valid phone number.
List the names AND ages of all permanent residents in your home, including yourself. *
Employer (Name, Address, Phone)*
Are you a student? If so, please list the name of your school.*
Will this be the first dog you've owned?*
List the current type of pets in your home and their ages. It's OK to estimate age. *
Have the pets been spayed/neutered? If no, please explain. *
Have you ever turned an animal into a shelter? If yes, please explain.*
Have you ever had a pet euthanized? If yes, please explain. *
Veterinarian (Name, address, phone number) *Please give permission for your vet to speak with us for reference and verification purposes.*
Where are your current pets kept at the home?*
Are they current on vaccinations? DHPP, Bordatella, current Heartworm Test and Prevention, Rabies.*

YesNoCurrent on vaccines, but not on prevention medication.Current on prevention medication, but not current on vaccines.I don't have other pets.
Have you had any other type of pets? If yes, please list them. *
If you have current pets, will they adjust to a dog entering the home?*

YesNoUnsureI don't have other pets.
What type of home do you live in?*

HouseApartmentCondoOther
Do you own or rent this property?*

OwnRent
Landlord's Name and Phone Number*
Do you have a yard?*

YesNo
Is your yard fenced? If so, how tall and what type of fencing?*
Do you have a dog door or gate? If so, please explain what type. *
Do you work outside of the home?*

YesNoI'm unemployed.
If you work outside of the home, how long will the dog be left alone? Where will the dog stay while you are gone?*
Have you discussed the adoption with all members in the household?*

YesNoI live alone.
Are there times when the dog will be tied up outside? If yes, please explain. *
Will you be willing to ensure the dog gets exercise on a regular basis?*

YesNoSometimes
If you go away on vacation or become ill, who will care for the dog?*
Are you willing to let us do a home visit to see where the dog will live prior to adoption?*

YesNoMaybe
What provisions will you make for the dog should you become unable to care for him/her?*
How much are you willing to spend on medical bills for the dog?*
What would you do if you needed assistance with vet bills?*
What activity level do you prefer for a dog?*
Please check all that apply. I want to adopt a dog for*

CompanionProtectionPlaymate for my dogFamily petGift for family/friend
Please check all that apply. My dog will...*

Be crated during certain times like at night or when I'm awayKept inside most of the timeBe left outside while I'm awayBe trained for off leashAttend formal trainingInteract with people regularlyHave free reign of the house while I'm awayBe included in all family functionsBe kept on a leash in publicGo on frequent walksGo to doggy daycareBe kept on a lead outsideTake frequent car rides to places
Please check all that apply. What would cause you to return the dog?*

GrowlingBitingCounter surfingChewingBarkingMouthingJumpingRough playAllergies/Medical NeedsDoesn't like other dogsFearfulI will do whatever it takes to keep this dog in my family
What do you feel is a reasonable amount of time for a dog to adjust to a new home?*

1 week1 month3 months6 months
How do you plan on introducing this dog into your family and/or other pets?*

Immediate introductions/Jumping into the mixSlow introductions over a period of time
Do you have or plan to get pet insurance?*

YesNoMaybe
What type of food do you plan on feeding your dog?*
Please provide a personal reference NOT related to or living with you. (Name and phone number)*
How did you hear about this dog?*
Date Signed*
By entering your name below, you acknowledge that you are signing this application. (Applicant)*

First NameLast Name
By entering your name below, you acknowledge that you are signing this application. (Co-Applicant)

First NameLast Name
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