Dog Adoption Form

Applicant's name

Address

Phone

Cell

In what type of housing do you reside?

Apt. / Condo

House

Other:

Do you rent this property?

Yes

Landlord's name

Landlord's phone

Do you plan on moving in the next 12 months?

YesNo

If yes, what do you plan to do with the animal?

Why do you plan to adopt this pet?

Companion for childCompanion for other dog

Companion for selfSecurity

House petWorking dog/mouse chaser

Breeding

Other:

Is this pet a gift for someone?

YesNo

If yes, who?

Have you previously owned pets?

YesNo

List all current animals and animals you had in the last 10 years:

List all veterinarians you have taken your pets to in the last 10 years and the veterinarian that you plan on using for this pet:

Veterinarian

Phone

Do you grant us permission to contact your vet(s)?

YesNo

Are there any children in your household or children who visit frequently?

YesNo

If yes, what are their ages?

In general, what type of discipline/corrections do you use with a pet?

Do you have a fence?

YesNo

If yes, how high, and what materials?

What percentage of time will this pet spend?

When this dog is outdoors, how will he/she be kept?

FreeFenceChain

LineKennel

Other:

In general, how many hours will this pet be left alone during the day? (at work, errands, etc)

Where will this pet be kept while you are away from home during the day?

CrateYard

BedroomGarage

Other:

Are you willing to provide your pet with MONTHLY heartworm prevention medicine at your own expense?

Yes

Are you willing to provide your pet with YEARLY vaccinations at your own expense?

Yes

Who will be financially responsible for all medical costs?

List any characteristics of an animal that would NOT fit your family or lifestyle:

Please provide two personal references NOT related to you:

First reference name

First regerence phone

Second reference name

Second regerence phone

Your request was acknowledged

Thank you for wanting to adopt a pet.

Your application will be reviewed, and we will contact you after approval process.