Dog Adoption Application
Please complete this application to be considered for dog adoption. All information will be kept confidential and used solely for adoption purposes.
Applicant Information
Full Name
*
Address
*
City
*
State
*
Zip
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Age
*
Number of people in household
*
Household members (names and ages)
*
Type of Residence
*
House
Apartment
Condo
Other
If Residence = Other, please describe
Do you own or rent your residence?
*
Please Select
Own
Rent
Landlord Name
Landlord Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Are pets allowed at your residence?
*
Please Select
Yes
No
Unknown
How long have you lived at this address?
*
Do you currently have pets?
*
Please Select
Yes
No
Current pets (Name / Type / Age / Spayed-Neutered)
Have you ever surrendered a pet?
*
Please Select
Yes
No
If you have surrendered a pet, please explain
Where will the dog primarily live?
*
Please Select
Indoors
Outdoors
Both
Do you have a fenced yard?
*
Please Select
Yes
No
If you have a fenced yard, what is the height/type?
How many hours per day will the dog be alone?
*
Where will the dog stay when alone?
*
Activity level of household
*
Please Select
Low
Moderate
Active
Who will be the primary caregiver?
*
Prepared to provide routine veterinary care?
*
Please Select
Yes
No
Prepared to provide emergency medical care?
*
Please Select
Yes
No
Prepared to provide daily food, supplies, and enrichment?
*
Please Select
Yes
No
How will you handle training?
*
Professional trainer
Classes
Self-training
How will you address behavioral issues?
*
Dog you are applying for (if specific)
Preferred age
Puppy
Adult
Senior
Preferred size
Small
Medium
Large
Energy level preference
Low
Moderate
High
Veterinarian Name (current or previous)
Veterinary Clinic Name
Veterinary Clinic Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Reference 1 - Name
*
Personal Reference 1 - Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Reference 2 - Name
*
Personal Reference 2 - Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Reference 3 - Name
Personal Reference 3 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Submit Application
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