Dog Adoption Application

Please read carefully and agree to the following terms and conditions by checking each item before completing the adoption application: 

Date *

Name and/or breed of dog you are inquiring about *

Name *

Age *

Address *

City *

State *

Zip *

Home Phone *

Cell Phone *

E-mail *

Employer Name for yourself *

Employer Name for your spouse

Employer Address for yourself *

Employer Address for your spouse *

Your employer's work phone *

Your spouse's employer's work phone

Your occupation *

Your spouse's occupation *

Your work hours *

Your spouse's work hours

What type of home do you live in? House
Townhouse
Condo
Apartment
*

Please provide landlord/property management contact info below to verify that pets are allowed.

How long have you lived at your current residence? *

Do you plan on moving in the next year? *

If yes, please explain *

Please list all those currently living in your home (name, age, relationship to you): *

Is anyone in your home allergic to pet dander? *

Please describe your allergy to pet dander

Is anyone in your home afraid of dogs (including housekeeper)? Yes
No
*

If yes, please explain

Does everyone in your home agree on adopting a dog? Yes
No
*

Please describe why you want to adopt a dog *

Please describe what qualities you are looking for in a dog *

Do you currently own any other pets? Yes
No
*

What type of pets do you have (include their names, ages, breed, are they neutered/spayed? Describe Personality): *

Have you ever owned a dog before as an adult? Yes
No
*

Did it ever have puppies? Yes
No
*

If you've owned a dog before and he/she is no longer with you, please explain and be specific. *

If you currently own or have owned a dog, please provide your veterinarian's name and phone number. *

Have you ever given up a dog or taken a dog to a shelter? Yes
No
*

If yes, please explain *

Do you have a fully enclosed fenced-in area on your property? Yes
No
*

If so, how tall is the fence?

Please describe your home and yard (ie: single family house 1/2 acres, dead-end, etc.) *

How do you plan to have your new dog relieve itself? *

Are you willing to take the time to house train a dog, and do you understand that changing a dog's environment may cause the dog to have accidents? Yes
No
*

How do you plan to exercise your new dog? *

How many hours each day will your new dog be alone? *

Who will be primarily responsible for the dog, feeding, taking outside, etc.? *

Who will care for your dog during prolonged absences (ie:vacation)? *

Specifically, where will your new dog be kept when it is alone? *

Specifically, where will your new dog sleep? *

What sort of training do you plan to provide your new dog? Please explain along with the methods of training. *

What behaviors do you find unacceptable for your new dog? *

Please list any additional pertinent information. *

Please provide 2 personal references (not relatives), including name, phone number and their relationship to you. *

Is this acceptable? Yes

Signature *

Date *

THANKS SO MUCH FOR WANTING TO HELP AN ANIMAL IN NEED.
 YOUR PET WILL NEVER FORGET THAT YOU SAVED ITS LIFE.