Adoption Application

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.Format: (000) 000-0000.

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.

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?

What type of home do you live in?

Other

Do you own or rent this property?

Landlord's Name and Phone Number

Do you have a yard?

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?

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?

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?

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?

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

Please check all that apply. My dog will...

Please check all that apply. What would cause you to return the dog?

What do you feel is a reasonable amount of time for a dog to adjust to a new home?

How do you plan on introducing this dog into your family and/or other pets?

Do you have or plan to get pet insurance?

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