Passion for Pooches Adoption Application

Today's Date

MonthDayYear

Dog Your Are Applying For:

Full Name

First NameLast Name

E-mail

Phone Number

Cell Phone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Occupation

Date of Birth:

Your Place of Employment:

Work Phone

Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Co-Applicant Name

Relationship to Applicant

Co-Applicant E-mail

Co-Applicant Phone Number

Co-ApplicantCell Phone Number

Co-Applicant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Occupation

Place of Employment:

Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Work Phone

Type of Home You Live in:

Do You Rent or Own Your Home:

If you are a renter, does your landlord allow pets?

Name of Landlord or Apartment Complex:

Landlord's Phone Number:

How many adults live in your household?

How many children live in your household?

Will you be the primary caregiver for this animal?

In the event of an emergency, who would care for your dog or what arrangements would you make?

How many hours would the dog be alone during the day

Please List All of Your Current Pets and Ages:

What Vet Do You Use?

Vet's Phone Number

I understand that my vet will be contacted for a reference regarding vaccinations, heartworm prevention and any other issues that may have occurred with your pets. By signing this application, you are giving your permission to contact your vet. Do you agree?*

YesNo

Have You Ever Given a Pet Away (to a shelter, rescue or returned to the breeder), if so, why?

Under what circumstance would you feel you HAVE to give up a dog?

What Groomer do you use?

Have you ever had an animal lost or stolen?

YesNo

Have you ever had an animal die as the result of being hit by a car or being poisoned?

YesNo

Have you ever had a dog or cat that gave birth?

YesNo

Please list any past pets:

What will be the pets living conditions?

Indoor MostlyOutdoor MostlyOutdoor OnlyNot Sure

Do you have a fenced yard?

YesNo

Type of fence?

Do you have a pool?

YesNo

Do you have a doggy door?

YesNo

What is the height of fence and size of fenced area

Are you willing to bring your pet to a vet for yearly exams and vaccinations?

YesNoNot Sure

Do you understand the expenses that come with owning a dog or cat? (Food, Supplies, Toys, Vet Care, Emergency Care, etc.)

YesNo

What kind of pet do you prefer?

SmallMediumLargeNo Preference

Do you currently have any pets?

YesNo

Types of Pet(s):

Sex and are they spayed or neutered?

Year(s) Adopted:

Age(s) Now:

Where did you get them?

Reasons for adopting:

Energy level preferred:

HighMediumLow

Breeds/Mixes Preferred:

Please List 2 References: (Names, Relationship, Phone Number)

If You Agree to All of the Above, Initial Here

By submission of this application, I/We assert that all statements and answers given in said application are the said truth. Any misrepresentation of the truth in this application will invalidate any subsequent volunteer agreement.

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