Adoption Application for Jack's Place

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Are you interested in a particular animal?

Animal's Name

Your Contact Information

Last Name *

First Name *

Street Address

City

State

Zip Code

Email address *

Home Phone Number

Work Phone Number

Mobile Phone Number

References

Veterinary Reference (Enter NA if you don't have a veterinarian) *

First and Last Name

Street Address

City, State and Zip Code

Phone Number

Personal References - Complete this section only if you don't have a veterinary reference.

Reference 1 Name

Reference 1 - Phone Number

Reference 1 - Email

Reference 2 - Name

Reference 2 - Phone Number

Reference 2 - Email

Your Pet History

List all pets owned in the last 10 years. Where are they now? If deceased, how did they die?

Your Household

List all household members and their ages (include anyone who visits on a regular basis): *

Is anyone in your family allergic to animals?

Yes

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Type of home where the dog will be living

Single Family Home

Condo/Apartment

Townhome

Other

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What is your ownership status?

Own

Rent (Landlord permission required)

What is your occupation?

What is your spouse's occupation?

Dog Knowledge and Commitment

Will you let dog off leash while walking?

Yes

Clear selection

If necessary, are you prepared to spend time housetraining?

Yes

Clear selection

Please describe your housetraining method

Will you conduct obedience training?

Yes

Clear selection

Will you take provessional training classes?

Yes

Clear selection

The Dog's Life

Is anyone normally home during the day?

Yes

Clear selection

If no, how long will the dog be alone?

If no, will someone take time off when the dog first arrives?

Yes

Clear selection

Please explain.

Where will the dog live (day and night)?

Will the dog be crated?

Yes

Clear selection

Please explain.

Do you have a fenced yard? *

Yes

If yes, what material is the fence made of and how tall is the fence? If no, how do you plan to contain the dog while outside.

Do you intend to be a multi-pet household?

Yes

Clear selection

If yes, how many pets do you intend to have in your home?

The Why and Wherefore

Why do you want a dog?

Why are you interested in this particular animal?

Will the dog be a house pet?

Yes

Clear selection

Will the dog be used for hunting?

Yes

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Are there any deal breakers for your new pet, i.e. gets along with cats, good with kids, good watch dog, or doesn't bark, etc.?

Any additional comments or questions?

Submit

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