TJDS Adoption Application

For Office Use Only: Approved Denied

Date

Applicants Name

Address No PO Box

City

State

Zip

Cell

Email

example@example.com

In what type of housing do you reside? Please explain your home:

In what type of housing do you reside

Do you rent

If so please provide Landlords Info

Landlords Name

Phone

Do you plan on moving in the next 12 months

If yes what do you plan to do with the animal

Why do you want to adopt this pet Please explain why you would like to adopt this pet

Is this pet a gift for someone

If yes who

Have you previously owned a pet? List all current animal you have and all animals you have had in the last 10 years

Have you previously owned a pet

Name

Sex

Breed

SpayedNeutered

Vaccinations

Still own

Name

Sex

Breed

SpayedNeutered

Vaccinations

Still own

Name

Sex

Breed

SpayedNeutered

Vaccinations

Still own

Name

Sex

Breed

SpayedNeutered

Vaccinations

Still own

Name

Sex

Breed

SpayedNeutered

Vaccinations

Still own

The TJDS requires that all animals in your household must be spayed/ neutered before adoption can or will be finalized List all veterinarians you have taken your pets to in the last 10 years and the veterinarian that you plan on using for this pet

Veterinarian

Phone

Veterinarian

Phone

Veterinarian

Phone

If more space is needed, please write on back or write it in an email you attach to this form to.

Do you agree to grant TJDS permission to contact your veterinarian

The Jeremiah Dog Sanctuary Giving Dogs A Fighting Chance Adopt Today!!!!! 227 Newell Ave Bronston KY42518 (606)872-7444 (502)465-3615

Are there any children in your household or children who visit frequently

If yes what are their ages

What types of discipline or corrections do you use with this pet Please explain

Will you be using a crate for the purpose of training

Do you have a fence

If yes how high

What materials

What percentage of time will this spend indoors outdoors

When this pet is outdoors how will he or she be kept fence chain line kennel etc

In general how many hours will this pet be left alone during the day

Where will this pet be kept while you are away from home during the day

Where will this pet be kept while you are out of town

Are you willing to provide this pet with monthly heartworm prevention medicine at your own expense

Are you willing to provide your pet with yearly vaccinations at your own expense

Who will be financially responsible for all medical cost

List any characteristics of an animal that would NOT fit with your family or your lifestyle

Please provide two personal references Name NOT related to you: Name

Name

Phone

Name

Phone

please include any information you would like for us to consider when reviewing your adoption application approval

Which pets are you considering

1. Once an adoption application has been submitted and has been approved the full amount of the adoption fee must be paid along with the full amount of the spay and neuter deposit (deposit is for puppies 6 months and under 2. Once the adoption and deposit fees have been paid the adopter will have one week to pick up said dog / puppy or the adoption will be voided and the application will be considered null-and-void. 3. If such an occurrence should occur there will be no refund given and the $150.00 spay and neuter deposit will be considered a donation to the TJDS and be deposited. 4. The dog / puppy in question will be put back up for adoption and should said person or person's fail to pick up said dog / puppy the adopter will be band from ever adopting from the TJDS again.

SECTION TWO OF THE ADOPTION APPLICATION STATES