ADOPTION APPLICATION

Name of Dog You're Applying For*

Full Name*

First NameLast Name

Birthdate*

Date

Cell Phone

Area CodePhone Number

Home Phone*

Area CodePhone Number

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long have you been at this address?*

Is this a rental property?*

YesNo

If yes, please provide the name of your landlord - if you answered no to the question above, type n/a:*

Name of the rental complex - if not a rental type n/a:*

Landlord's phone number - if not a rental type n/a*

Property type:*

HouseCondoApartmentLive with Relatives

Is the yard fenced? If you answered yes, describe the type and height of your fence.*

How many Adult residents in your household?*

List Adult names and ages, if no other adults type n/a:*

How many Children residents in your household?*

List Children names and ages, if no children type n/a:*

Are you a:*

First-time adopterHad a dog(s) growing upAlways had a dog

Do you have any other pets at this time? If so, please list breed and age of each pet. Please include all animals on the property.*

Please list the name, address and phone # of your current veterinarian. A veterinarian must be established before an adoption occurs.*

Who will be the primary caretaker of the dog?:*

How long will the dog be alone daily?:*

0-5 hours6-10 hoursOver 10 hours

Where will the dog be kept while alone?:*

My ideal dog would be:*

MaleFemale

IndoorOutdoorBoth

Active/athletic jogging, swimming, hikingSemi active/enjoys walks on leash, plays fetchLap dog/quiet, requires little or no exercise

House trainedWilling to house train

Why did you choose this particular dog?*

What do you know about the breed of the dog that you are applying for?*

How much daily exercise will you provide for the dog?*

Where will the dog sleep?*

Where will the dog stay while you are on vacation?*

Are you willing to make a lifetime commitment to your dog even if you experience lifestyle changes such as: divorce/marriage, moving, children, job change, etc?*

YesNo

What problems would make you return the dog:*

Have you ever surrendered an animal to a shelter?*

YesNo

If yes, please explain. No, type n/a*

Have you ever adopted from us?*

YesNo

If you answered yes to the question above, please provide the date(s) of your adoption(s) and the dog's Shelter name. If you answered no to the question above, type n/a*

I certify that the above information is true to the best of my knowledge and that falsification of this information can be cause for denial of my application, revocation of the contract and/or removal of the dog*

/s/ Your Name

Date*

Date

How did you hear about Adopt a Pet?*

BACKGROUND CHECK ACKNOWLEDGMENT. In our continued effort to ensure the health and safety of the dogs, our volunteers, and our facility, we conduct background checks on potential adoption applicants prior to scheduling an appointment at Adopt-A-Pet. There is no charge to you for this process. Once the Adoption Staff has conducted the preliminary interview and you want to move forward in the process then your data may be submitted to be reviewed. We appreciate your understanding and cooperation.

My signature indicates that I have read and understand that I may be subject to a background check prior to adopting a dog from Adopt-a-Pet.

Signature

Date

Enter the message as it's shown*

By clicking SUBMIT I:

Confirm the information I have given above is true and complete. The dog will reside in my home as a lifetime companion. I will provide him/her with adequate food, water, shelter, training, affection, medical attention and regular vet visits.

Agree with Adopt-a-Pet's terms for adoption and realize that giving false statements will result in denial of adoption.

Understand submitting this form does not guarantee adoption of the dog I selected.

Agree that if, for any reason, I can no longer care for or keep the dog, I must return it directly to Adopt-a-Pet, and I will sign all necessary papers for the surrender of the dog.

Understand the information I provided is used by Adopt-a-Pet solely in evaluating my qualifications to adopt a dog and in deciding whether I am the most suitable adopter for a particular dog.

Release Adopt-a-Pet and the Internet Service provider and any and all other parties involved in developing, using and maintaining this site from any claims of liability due to release of any information contained in, or related to, my Adoption Application. I am voluntarily submitting the requested application information online at my own risk.

After you submit your application it will be reviewed and a volunteer from Adopt a Pet will contact you. Please allow a few days for this process as Adopt a Pet is a volunteer run organization.