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Adoption Application for Jack's Place
Are you interested in a particular animal?
Animal's Name
Your answer
Your Contact Information
Last Name
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First Name
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Street Address
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City
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State
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Zip Code
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Email address
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Home Phone Number
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Work Phone Number
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Mobile Phone Number
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References
Veterinary Reference (Enter NA if you don't have a veterinarian)
First and Last Name
Your answer
Street Address
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City, State and Zip Code
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Phone Number
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Personal References - Complete this section only if you don't have a veterinary reference.
Reference 1 Name
Your answer
Reference 1 - Phone Number
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Reference 1 - Email
Your answer
Reference 2 - Name
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Reference 2 - Phone Number
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Reference 2 - Email
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Your Pet History
List all pets owned in the last 10 years. Where are they now? If deceased, how did they die?
Your answer
Your Household
List all household members and their ages (include anyone who visits on a regular basis):
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Is anyone in your family allergic to animals?
Type of home where the dog will be living
What is your ownership status?
What is your occupation?
Your answer
What is your spouse's occupation?
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Dog Knowledge and Commitment
Will you let dog off leash while walking?
If necessary, are you prepared to spend time housetraining?
Please describe your housetraining method
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Will you conduct obedience training?
Will you take provessional training classes?
The Dog's Life
Is anyone normally home during the day?
If no, how long will the dog be alone?
Your answer
If no, will someone take time off when the dog first arrives?
Please explain.
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Where will the dog live (day and night)?
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Will the dog be crated?
Please explain.
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Do you have a fenced yard?
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.
Your answer
Do you intend to be a multi-pet household?
If yes, how many pets do you intend to have in your home?
Your answer
The Why and Wherefore
Why do you want a dog?
Your answer
Why are you interested in this particular animal?
Your answer
Will the dog be a house pet?
Will the dog be used for hunting?
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.?
Your answer
Any additional comments or questions?
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