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

CityState

Zip Code

Adopter's E-mail

Phone Number

Area CodePhone Number

Phone Type

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?

Does anyone in your home fear dogs?

I/We live in a

Do you rent or own this property?

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?

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?

Other

Please check all that apply. I want to adopt this dog...

Please check all that apply. My adopted dog will...

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?

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?

Name

Phone Number

Email

Relationship

Name

Phone Number

Email

Relationship

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.

Applicant's Signature

Co-Applicant's Signature

Signature date

Reference #1

Reference #2

Reference #3