Joy Committee Adoption Application

Full Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Who are you applying to adopt?

Do you own your residence?

Landlord's Name and phone number

Street Address, City, State, Zip

How many hours will the dog be left alone during the day?

Who will be responsible for caring for the dog?

Do you have children? This doesn't disqualify you, however some dogs don't do well with children, some do!

YesNoNo, but I have children in the household

What behavior traits would absolutely not be acceptable to you and would cause you to return a dog?

What are the ages of household members?

Who will be responsible for caring for the dog when you aren't home or go on a trip?

How will you confine your dog when you're not home?

If you move, what will you do with your dog?

How do you plan to exercise your dog? Check all that applies

List your Vet's name, address and telephone number

Previous Veterinarian if applicable?

Employer name

Length of time you have worked here?

Have you ever been charged with or convicted of any crime involving animal cruelty, neglect or abandonment?

YesNo

Have you owned a dog before?

YesNo

Have you ever had to give an animal away?

YesNo

Have you ever had an animal hit by a car?

YesNo

Have you ever had an animal die of any reason other than old age?

YesNo

The average cost of feeding and caring for a healthy medium sized dog ranges from $600 to $2000 per year, are you financially able to provide food for a dog?

YesNo

Do you have a fenced yard?

YesNo

If your dog ended up needing extensive vet care, would you be able to financially provide care for your dog?

YesNo

How do you plan to help the dog/cat adjust to it's new home?

Please list two personal references with phone numbers:

Please explain any answers that need explaining

Why do you want to add this dog to your family?

Please list all pets in your household, including age, breed, where they are kept and if they are spayed, neutered and vaccinated

Please list any pets you have had over the last 7 years including where they were kept, if they were vaccinated and how many years they were a part of your family

Disclaimer/Signature

Please initital each box that you have read and agree to the below statements. Your initials and signature are legally binding, and enforceable by law.

I have answered all the screening questions truthfully to the best of my ability. I understand that any misrepresentation of this information is grounds for refusal of adoption

I understand that my State/County may have leash laws that I have to abide by

I understand and agree that if at anytime my pet needs to be returned to rescue, I must inform the Joy Committee in writing and with a 21 day notice and I agree to retain the dog until I am given written permission of the Joy Committee to do otherwise

I understand that submission of my application is not automatic grounds for approval

I understand that a "home visit" may be required to complete my application

I understand that my typed name will be used as my legal signature and agreement

Full Legal Name (Electronic Signature)

Drivers License Number