ADOPTION Application Form

ADOPTION APPLICATION
How did you hear about Earthdog Rescue?
Full Name*

First NameLast Name
Age
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number - Home

Area CodePhone Number
Do you live in a:
Do you:

OwnRentOther
If you rent, we will require a letter from the landlord stating you are permitted to have a dog. Are you able to acquire this paperwork should it be needed?

YesNo
Household Setting

RuralSuburbanUrban
Please List all People and pets living in the Household (Include Name, Relationship, Gender and Age)*
Name of animal you are interested in adopting*
Why do you want to add a pet to your home?*
We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

YesNo
Do you have a fenced yard?

YesNoPartial
If fenced, please give details on height, material, # of gates, are gates locked or lockable?
Vet Reference: Full Name*

First NameLast Name
Phone Number

Area CodePhone Number
Reference #1: Full Name*

First NameLast Name
Relation to applicant(s):
Phone Number

Area CodePhone Number
Date

MonthDayYear
Your name*
E-mail
Should be Empty:

ADOPTION APPLICATION