VOLUNTEERS FOR ANIMAL PROTECTION
Our goal is to place companion animals in permanent, loving homes. Please complete this application and contract so that Volunteers for Animal Protection may assist you in finding a special, compatible companion to join your family. Please note that we do not adopt companion animals on a "first come, first served" basis, but rather make every attempt to match families with the most appropriate companion animals. WE RESERVE THE RIGHT TO DECLINE ANY APPLICATION. YOU MUST BE AT LEAST 21 YEARS OF AGE TO ADOPT AND YOU MUST ALSO BE RESPONSIBLE FOR MAINTAINING A HOUSEHOLD. PLEASE DO NOT LEAVE ANYTHING BLANK. It will only slow the process down.
ADOPTION APPLICATION
(Please print clearly)
NAME:
Name of dog in which you are interested:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Breed/Description:
Male/Female
Release for Veterinary Reference (to be completed by potential adopter) if you have a current vet.
I, ________________________________________________ hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to Volunteers for Animal Protection..
(signature)
My current veterinarian is
located at
and can be reached at
Format: (000) 000-0000.
Personal References: Do not list any relatives or anyone living in the home.
1. Name
Phone Number
Format: (000) 000-0000.
Relationship
2. Name
Phone Number
Format: (000) 000-0000.
Relationship
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VOLUNTEERS FOR ANIMAL PROTECTION
Age:
Email:
example@example.com
Address (include City, State, and Zip Code)
Home phone
Format: (000) 000-0000.
Work phone
Format: (000) 000-0000.
Cellphone:
Format: (000) 000-0000.
Driver's License #
Facebook page address:
Employer
Position
What are your hours?
How long have you been employed in this position?
Spouse/Partner: Employer
Position
Wk ( )
Spouse/Partner cell phone
Format: (000) 000-0000.
What are their hours?
What are you looking for in a companion dog?
Family dog
Companionship
Guard Dog
Child’s Companion
Companion for another animal
How long would dog be left alone?
Where would this dog stay during the day?
Night?
Do you or your spouse/partner travel frequently?
If so, how often?
What will you do with dog when you travel?
What will you do with this dog if you have to move?
Are you willing/able to purchase and use a crate if needed or advised?
Do you have a doggy door?
How would you handle the dog's potty needs?
How would you exercise this dog?
Where will this dog sleep?
Does anyone in the household have allergies? If so, are they allergic to animal dander?
Do you have children/grandchildren?
What are their ages?
Do they live in the household? If they do not live with you, how often do they visit?
Are you willing and able to commit to behavior and/or dog obedience training?
Do you own, rent, or lease?
House, apartment, mobile home?
How long at this location?
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VOLUNTEERS FOR ANIMAL PROTECTION
If renting/leasing, does your lease allow companion animals?
Breed or weight restrictions?
Animal deposit?
(We will need confirmation of payment/payment waived of any required deposit.)
Rental manager's name and phone number
Do you have a fenced yard?
What type of fence and how high?
Are you prepared to meet the financial responsibility of owning a pet? (A cost of $300.00 to $1000.00 per pet, annually.)
YES
NO
What kind of food will you feed this dog?
Brand of kibble:
Canned:
Other:
Which of the following reasons might prompt you to give up your companion animal? (check all that apply)
Excessive barking
Biting
Fighting with other dogs
Digging
Moving
Divorce
Poor watchdog
Destructive chewing/scratching
Financial problems
Shedding
Allergies
Growling at guests
Excessive vet bills
Occasional accidents indoors
Aggressive on leash
New spouse/partner does not like
Jumping fence
New Child
None of the above
If a problem with the dog's behavior arises would you be willing to seek help immediately from the rescue group and/or a trainer?
Have you owned this breed/mix before?
Have you owned a rescue animal before?
Have you ever adopted from a rescue group or shelter?
what group/shelter?
Have you applied to adopt an animal and been declined?
why?
Have you ever given up animal(s)?
why?
What did you do with the animal(s)?
What qualities are you looking for in a dog? (Please be specific)
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VOLUNTEERS FOR ANIMAL PROTECTION
What traits or characteristics are you sure you do NOT want? (Please be specific, please also indicate activity level you are looking for in a companion animal)?
Please provide info for whoever would take over the care of your companion animal if you became incapable of doing so or upon your death and contacting the rescue. (Please list someone outside the household) Please provide their information below.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Do you give permission for a Volunteers for Animal Protection representative to visit your home prior to adoption to do a home check and after adoption to do follow up checks on this dog?
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VOLUNTEERS FOR ANIMAL PROTECTION
COMPANION ANIMAL OWNERSHIP HISTORY Current and Past (last 5 years)
Do you or did you have other companion animals ?
If yes, please list below.
*Name
*
Dog or cat?
How acquired?
Breed
Male or Female?
Spayed/neutered?
Age of companion animal
Length of ownership
Is/was the animal on Heartworm preventative?
Kind of Heartworm preventative?
When last given?
Is your companion animal current on all shots?
If no, please explain.
Where does/did the companion animal sleep?
Where does/did the companion animal stay while away or at work?
Does/did the companion animal have any problems or conditions?
If you no longer have this companion animal, what happened to the companion animal? Be Specific:
*Name
*
Dog or cat?
How acquired?
Breed
Male or Female?
Spayed/neutered?
Age of companion animal
Length of ownership
Is/was the animal on Heartworm preventative?
Kind of Heartworm preventative?
When last given?
Is your companion animal current on all shots?
If no, please explain.
Where does/did the companion animal sleep?
Where does/did the companion animal stay while away or at work?
Does/did the companion animal have any problems or conditions?
If you no longer have this companion animal, what happened to the companion animal? Be Specific:
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VOLUNTEERS FOR ANIMAL PROTECTION
*Name
*
Dog or cat?
How acquired?
Breed
Male or Female?
Spayed/neutered?
Age of companion animal
Length of ownership
Is/was animal on Heartworm preventative?
Kind of Heartworm preventative?
When last given?
Is your companion animal current on all shots?
If no, please explain.
Where does/did the companion animal sleep?
Where does/did the companion animal stay while away or at work?
Does/did the companion animal have any problems or conditions?
If you no longer have this companion animal, what happened to the companion animal? Be Specific:
Signature:
Print:
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