Dog Adoption Application
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this address?
*
Are you planning on moving in the next 6 months?
*
Yes
No
If yes, what are your plans for your pets when you do?
Primary Phone Number
*
-
Area Code
Phone Number
Secondary Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
What are the most convenient times to contact you?
*
Date of Birth
*
/
Month
/
Day
Year
Date
Do you own your home?
*
Yes
No
Type of Dwelling
*
Please Select
House
Apartment
Condo
Mobile Home
If you do not own your home, please provide your landlords name and contact information
Name and age of all household occupants (Including Yourself)
*
If no children, do you plan on having children or will there be children frequently in the home? Please select all that apply.
Planning to have children
Not planning to have children
Children frequently visit
Children do not frequently visit
What are your reasons for adopting a dog? Select all that apply. If other, please specify
*
Companion for myself/my family
Companion for another animal
Gift
Livestock guardian
Guard dog
Other
How many hours per day will your dog be left alone?
*
How many hours per day will your dog be left alone outside?
*
If adopting a puppy, where will the puppy be left when alone?
*
Do you have a fenced in yard?
*
Yes
No
If yes, what type of fence do you have?
Chainlink
Wood
Splitrail
N/A
If yes, how tall is your fence?
If yes, do you have locks and/or latches on all gates?
Yes
No
Do your current dogs or will your adopted dog be left outside on a run or chain?
*
Yes
No
Are any members of your household allergic to animals?
*
Yes
No
Who will have chief responsibility of care for your new pet?
*
In the past 5 years, how many pets have you owned?
*
Please Select
0
1
2
3
4
5
6+
Do you currently have pets in your home?
Yes
No
List each pet you have had or have, including age, species, spay/neuter status, and if they are not still in your care, why?
*
If you have pets, how do they react to new animals?
*
Are your current pets up to date on all vaccines?
*
Yes
No
N/A
If no, why not?
Have you and your spouse ever owned a pet together?
*
Yes
No
N/A
Have you ever lost or given away a pet? If yes, why?
*
How much are you prepared to spend annually on routine care and emergencies including but not limited to food, possible medications, and emergency surgeries?
*
What plans do you have for your new pet when you go on vacation/what arrangement do you have for your current pets?
*
Are there specific dogs you are interested in? If so, please list the name(s) here
What age ranges or circumstances would you be interested in adopting? Select all that apply
*
Puppy, 8 weeks to one year
Young, 1-3 years
Adult, 3-10
Senior, 10+
Bonded pair
Special needs
Please describe what you would do if your dog began to display unwanted behaviors? (jumping, growling, biting, potty accidents, etc)
*
Are all household members in agreement about bringing home a new dog?
*
Yes
No
Special Circumstance
If special circumstances apply, please explain
Are you prepared to care for the pet for the next 15-20 years of it's life?
*
Yes
No
Has anyone in your home been charged with animal cruelty, abuse, or neglect?
*
Yes
No
If yes, please describe
Have you ever adopted/tried to adopt a pet from us?
*
Yes
No
If yes, please provide the pets name and adoption/application date.
Pet's name
Adoption/Application date
Please provide a recent vet reference, including the Doctor's name, clinic's name, and clinic phone number.
*
Personal References
Please provide 2 reference. Only one may be a relative. In addition, please let your references know we may be calling.
Reference 1 Name
*
First Name
Last Name
Reference 1 Phone Number
*
-
Area Code
Phone Number
Reference 2 Name
*
First Name
Last Name
Reference 2 Phone Number
*
-
Area Code
Phone Number
If there is anything else you would like to share, please do so here. Thank you for your interest in one of our amazing furry friends.
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