Dog Adoption Form

Name of Dog Desired OR Breed, Type, Size and Age Preferred:
Potential Adopter Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
How many people live in your household?
List all ages for children under 18:
What type of household do you live in (house, apartment, condo):
Do you own or rent?

OwnRent
If renting, please proName of Landlord/Manager

First NameLast Name
Are dogs allowed?

YesNo
Are there any restrictions to dog ownership, such as size or breed?

YesNo
If so, what are those restrictions?
Type of location (urban, rural, etc)
Is this a busy street?
What is the speed limit?
Where will the dog live? (inside, outside, kenneled, etc.)
Where will the dog spend most of his/her time?
Is your yard fenced? If so what type?
What kind of exercise will the dog receive?
Is the dog to be left alone? If so, how long, how often, and will the dog have free run or be crated?
Describe the activity level in your home (busy, social, quiet, etc)
How many dogs live in your home now?
Please list the names, ages, how long you have had them, breed type, and if they are spayed/neutered.
Have you had other dogs in the past, and if so what happened to them?
What other pets and animals have you had?
Landlord/Manager's Phone Number

Area CodePhone Number
References (other than relatives)

*If you do not include 3 references, we cannot process your application! Also, please include your current veterinarian. If you do not have a current vet, please include a past vet (even if it is out of state). If you have never had a veterinarian, please state that. Blanks will hold up processing your application.
1. Name

First NameLast Name
1. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
1. Phone Number

Area CodePhone Number
2. Name

First NameLast Name
2. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
2. Phone Number

Area CodePhone Number
2. Name

First NameLast Name
3. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
3. Phone Number

Area CodePhone Number
Veterinarian's Name

First NameLast Name
Veterinarian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Vet's Phone Number

Area CodePhone Number
By signing this application, you are stating that all of the information is true to the best of your knowledge. You are also giving Middle Tennessee Treasures, and volunteers, permission to verify your information and contact the references you have given.

Please let us know if you decide not to pursue this adoption so we can halt work on your application.
Initial here to sign:
Date of signature:

MonthDayYear
Should be Empty:

References (other than relatives)