Aretas Assistance Dogs Adoption Form
Name (Adopter 1)
First Name
Last Name
Age
Name (Adopter 2)
First Name
Last Name
Age
Phone Number (Adopter 1)
-
Area Code
Phone Number
Phone Number (Adopter 2)
-
Area Code
Phone Number
Email (Adopter 1)
example@example.com
Email (Adopter 2)
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation (Adopter 1)
Occupation (Adopter 2)
Which dog are you interested in adopting?
Do you own or rent your house?
Own
Rent
If you rent, what is the pet policy?
What kind of home do you live in?
Single Family
Townhouse
Apartment
Other
What kind of fencing do you have?
If no fencing, what are your plans for exercising the dog?
Are there children living in your home? If so, what are their ages?
Do you plan on adding children to your family in the future?
Yes
No
Do children visit your home regularly?
Yes
No
How many adults and children live in your home?
If you own other animals, what kind, what genders, and what ages?
Please describe dogs you have owned in the past and what happened to them
Have you ever surrendered a dog to a shelter? If so, please explain
Have you ever given up a pet to a new home? If so, please explain
Where will your dog stay while you are gone?
Where will your dog be when you're at home?
How many hours a day will your dog be home alone?
Are you willing to take your dog to a training class?
Yes
No
Are you willing to crate train your dog?
Yes
No
Are you prepared for sudden veterinary expense in case of an emergency?
Yes
No
What kind of dog food are you planning to feed?
What would you do with your dog if you had to move or had a sudden emergency situation?
Does anyone in your home have allergies to dogs?
Yes
No
What traits are you hoping for in a dog?
What traits would you like to avoid in a dog?
Tell us a little about why you're considering adopting and what you are looking for
Are you willing to have a home visit conducted so we can make the best match for your family and our adoptive dogs?
Yes
No
Reference 1 (Name, number and relationship)
Reference 2 (Name, number and relationship)
Veterinary reference (Clinic and doctor's name)
By typing your name in this box, you are agreeing to digitally sign this application and testify that the above information is true and contains no relevant omission of information
Date
-
Month
-
Day
Year
Date
Submit
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