Adoption Application Form

Personal details

First NameLast Name

Email Address

example@example.com

Phone Number

Format: (000) 000-0000.

Is there a specific dog that you are interested in adopting?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?

Please list the pets that you have at home

Rows	Pet name	Age	Gender	Species	Breed	Sterilized	If not, explain why
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6

Pet's behavior towards other dogs?

Veterinarian Practice

Practice nameVet name

Veterinarian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Do you own or rent your home?

Please provide your landlord's information here:

Do you have a yard?

Is it securely fenced? please describe

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?

Please list everyone living on the property, inclusive of children and staff

Rows	Name	Age	Relation to you
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6

Do children (12 years or younger) visit your home?

Will you be willing to take your new dog to puppy school/ dog training classes?

Why do you want to adopt a pet?

How many hours per day would the pet be alone?

Please specify time frame

Where does your pet sleep at night?

Where on your property are pets not allowed?

Will you crate your pet?

If yes, for what purpose will you be crating your pet?

If you have to leave town, emergently or planned, where would your pet stay?

If your circumstances where to change (immigration, downsizing, starting a family, financial difficulty), what provision would you make, or already have in place, for your pets?

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?

Please provide a detailed description:

By clicking the submit button, I agree to proceed with the adoption process which includes a homecheck and interview.
By clicking the submit button, I understand there is an adoption fee attached to the dog you want to adopt.
By clicking the submit button, I agree to indemnify The Gem Project against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that The Gem Project will disclose any of the pet's health or behavior issues known before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be obligated to return the adoptive dog back to The Gem Project.
By clicking the submit button, I verify all of the above information is true and accurate.

Date

Signature of Potential Pet Parent