Dog Adoption Application

Name of the dog you want to adopt *
Adopter's Name *
First & Last Name
Co-Adopter's Name
First & Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Adopter's E-mail *
Phone Number *

Area Code Phone Number
Phone Type *

Cell Home Work
Names and ages of all permanent residents of your home (adults/children) *
Current pets in your home: Species, Breed, Name, Age, Sex, Altered yes or no?
Vet reference (please call your vet and give permission to release information to us) *
Vet name, address & phone number
Is anyone in your home allergic to dogs? *

Yes No
Does anyone in your home fear dogs? *

Yes No
I/We live in a *

Single Family Home Duplex/Twin Condo/Townhome Apartment
Do you rent or own this property? *

Rent Own
If you rent, you must obtain permission from your landlord or provide a copy of the section of your lease stating that you are allowed to have pets and showing any limitations.
Name of Landlord
Landlord Phone Number
Do you have a yard? *

Yard, fenced with a vertical fence Yard, fenced with invisible fencing Yard, no fence No yard (apartment/condo/townhome)
How many hours per day will this dog be alone? Explain *
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain. *
What activity level do you prefer?

Wild and crazy is cool Leash trained daily jogging partner would be excellent Medium energy, plays a bit then hangs out with you Low energy, walks slowly on leash, a total couch potato
Please check all that apply. I want to adopt this dog... *

As a family pet To train/use for hunting To train/use as a therapy dog To train/use as an assistance dog for the disabled For a jogging/hiking partner As a companion for my dog(s) As a companion for my cat(s) As a companion for my child/children
Please check all that apply. My adopted dog will...

Be crated when we are not home Have free reign of the house when we are not home Be taken to formal obedience classes Be trained by me/us Take frequent car rides with us Be kept on a lead line/cable in the yard Be mostly interacting with adults Be interacting frequently with children under 8 Be interacting frequently with older children Be boarded when we go on vacation Stay with family when we go on vacation
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog? *

Housebreaking Chewing Jumping Pulling on leash during walks Obedience training Fear of men Fear of women Fear of children Mouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training) Growling Barking Rough play with my dog High activity level Food/toy aggression/not willing to share with other dogs Food/toy aggression with people Whining/crying Blindness Limited Sight Deafness Separation Anxiety Diabetes Special Diet Long Term Medication Taking classes with the dog Gets stressed/carsick when riding in vehicle Doesn't know how to climb stairs Can't climb stairs due to age/arthritis/health issues Heart condition Skin allergies Food allergies Trimming nails I will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.
What would cause you to return a dog? *
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family? *
How do you plan to integrate this dog into your family? *
How long have you been looking for a dog? *
Reference #1
Name *
Phone Number *
Email
Relationship *
Reference #2
Name *
Phone Number *
Email
Relationship *
Reference #3
Name *
Phone Number *
Email
Relationship *
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog? *
Please read the above, check this box, sign, and click Submit. *

I/We have read and understand all of the above.
Applicant's Signature *
Co-Applicant's Signature
Signature date *
Should be Empty:

Reference #1

Reference #2

Reference #3