Contact Information:

Applicant Full Name: 

Age:
Co-Applicant Full Name:
Age:
Complete Home Address:
City: State: ZIP: 

Home Phone Number:
Best Time to Call:
Email Address 

Cell Phone:

Occupation:
Business Address and Phone:

Household Information

Number of Children:                   Their ages

What breeds of dogs have your children lived with? 
How long have you lived at this address? 

Which best describes your current home? 

House        |Condo               |Apartment              |Mobile Home
Rent          | Own                  | Live with Parent

Please provide the name and phone number for your landlord (renters) or land owner (mobile home)

Please list all of the members of your household, whether they are relatives or not. (name, age, relationship)?

Does your home have a yard?

Is it completely fenced? Is gate padlocked? Is fence secure underground?

Adoption Information

Why do you want to bring a new pet into your home?

Is everyone in your household in agreement on adopting a pet?

Where will your dog spend most of its time? Inside                | Outside                  | Basement           | Other (specify)

What provisions will be made for your pet when no one is home during the day?

What provisions will be made for your pet when no one is home during the evening?

What provisions will be made for your pet when you go on vacation?

Do you prefer to adopt a male or female dog?           Age Range? 

Is there a particular pet on our web site that you are interested in? Which one(s)?

Which trainer do you plan to use with your adopted dog? 

We can recommend many very good trainers in our area. Please ask for a list if you need a referral.

What activities do you plan to do with your adopted dog? 

Will this dog be used as a guard dog? 

Under what circumstances would you give up your dog? 

Current Pet Information

Do you have any pet(s) currently? List type, breed, age, & sex.

Tell us about the pets you have owned over the past 10 years, i.e. type of pet(s), how many years you owned them, reason for no longer owning them.

Have any of your pets ever been lost or injured?  If yes, please provide explanation.

Veterinarian's Name & Phone Number. Please also tell us what name the pet is under at the vet's office.

Are your pets current on vaccinations? 

Are your pets spayed/neutered?

Are your pets on heartworm preventative? What brand?

When did you visit your veterinarian last? 

All of the dogs placed have undergone thorough temperament evaluations and have lived with foster families prior to their adoption.While in foster care, we begin training and work to resolve any behavioral obstacles before adoption. Generally we are only able to give you the dog's history from the time it enters our program. Are you able and willing to continue working on these challenges with us to ensure that your adopted dog is a respectable canine companion and family member? Your comments are encouraged.

Please provide the name and contact information of two persons, not related to you, who are able to discuss your pet-owning abilities.

 

Reference #1 (name, relationship, evening phone number, email address):

Reference #2 (name, relationship, evening phone number, email address):

Additional Comments: 

We ask an adoption fee to help cover our costs of spay/neuter, all shots, microchip and transport, usually ranging from 150. to 200.  Please let us know if you are in agreement with this. 

Please read:

I certify that the information I have provided on this form is true, correct, and accurate. I am financially and physically able to care for the animal that I adopt. I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreement . I understand that there is no obligation to adopt an animal to me, now or in the future.  I understand that my electronically-generated signature [below] is valid as a means of legal signature for the purpose of this adoption application (Yes or No) :   _________________

Signature:                                       Date:

 

~THANKS SO MUCH FOR WANTING TO HELP A PET IN NEED ~

 ~YOUR DOG WILL NEVER FORGET THAT YOU SAVED ITS LIFE~