West Jersey Volunteers for Animals
Please complete this Adoption Application in its entirety. There are 25 questions and should take approximately 10 minutes or less. Once you click the Submit button you will receive a Confirmation message. If you do not, a question(s) may be incomplete and will be highlighted in red.
We Adopt only within a 75-100 mile radius to the Cherry Hill NJ area. We visit your home as the last step of the adoption process when we bring the dog to you, so you can experience the dog in your home.
Our Adoption Fees are: $250 for Adult dogs 6 mon-8 yr, $150 for Senior dogs, 9 yr and up, and $300 for puppies 10 wks to-5 months.
We will be in touch with you within 48 hr. of receiving your application and approving it.
Thank you for applying to adopt.
Name of Pet(s): *
Which dog(s) are you interested in adopting?
Your answer
Name of Applicant: *
Your answer
Name of Co-Applicant: *
include Spouse/Partners
Your answer
Date *
MM
/
DD
/
YYYY
Occupation, Employer, and Work Hours of Applicant: *
Your answer
Occupation, Employer, and Work Hours of Co-Applicant: *
Your answer
Names and Ages of ALL people living in the home including Applicants *
Must list all Ages. Also include any small children that may visit very often like Grandchildren.
Your answer
Street Address, City, State Zip Code *
We adopt our dogs no further than approx. 75-100 miles from the Phila. area.
Your answer
Email address of primary contact(s) *
Your answer
Home Phone: *
Your answer
Cell Phone #1 *
Your answer
Cell Phone#2 *
Your answer
Thank you for considering adopting a dog from WJVA.
You will be making a commitment to the dog you adopt and our goal is to help make the best match possible for you and the rescued dog. All family members must meet the dog you want to adopt. We do not adopt our dogs for surprise gifts.
The following questions will help us achieve that goal.
1. What type of Residence do you live in? *
2. Do you have a complete fenced-in backyard? *
We do not adopt to homes with Invisible Fencing
3. If you have a fence, describe the Height and Type of fencing: *
If you don't have a fence please mark N/A
Your answer
4. Do you currently rent, own, or lease? *
5. If you Rent, is there any Breed or Size Restrictions? What is the name and telephone number of your Landlord? *
Will be verified by your Landlord
Your answer
6.. Is anyone in the household allergic to pets? *
If yes, how will they manage their allergies?
Your answer
7. Do you have any preference as to breed, size, sex, age, length of hair? *
Your answer
8. Describe the ideal dog for your lifestyle: *
Are you Active, Laid Back, a little of Both?
Your answer
9. What attracted you to the dog you are applying for? Is there a dog in your family or with friends that your new dog needs to meet and be good with? *
Your answer
10. How many hours will the dog be alone during the day? Do you use a Dog Walker? *
Your answer
11. Where will the dog be kept when no one is home? What are your feelings about crate training? We do recommend crating you safety and housebreaking reasons. *
Your answer
12. Where will the dog be kept at night? *
Your answer
13. List CURRENT PETS and Where did you get these pets? How long have you had your current pets? *
NAME| TYPE |BREED |SEX |AGE | SPAYED/NEUTERED? | VACCINATIONS,
Your answer
14. List PREVIOUS PETS *
NAME| TYPE |BREED |SEX |AGE | SPAYED/NEUTERED? | REASON FOR LOSS/CAUSE OF DEATH
Your answer
15. What Brand name of food do you plan on feeding your new pet? What Brand name do you feed currently? *
If you do not have any pets we will suggest some healthy all natural foods for you to choose.
Your answer
16. Who will be the primary caretaker for the dog? *
We recommend the whole family takes part in caring for your dog, if age appropriate.
Your answer
17. Have you ever given up a pet or turned a pet into a shelter or rehomed a pet? *
If yes, please explain.
Your answer
18. Under what circumstances would you not keep this dog? *
Your answer
19. What are your feelings on basic training for your dog and your family? *
We recommend some type of training for your new dog and your family to go through together.
Your answer
20. Have your Children Lived with dogs Before? Any of the children scared of dogs? *
Your answer
21. If your new pet develops a medical problem that becomes expensive, what would you do? *
Your answer
22. Please check the topics you would like our staff to discuss with you. *
Required
REFERENCES
Please contact your veterinarian’s office to let them know we will be contacting them. Due to privacy issues many veterinarians will not give out information without the consent of their client and this will save time.
23. Please list the Current and Previous veterinarian(s) your pets have seen. *
Name(s) and phone numbers:
Your answer
24. Please provide 2 personal references of those not related to you
Names and phone numbers:
Your answer
WJVA will require a home visit as part of the adoption process.
By signing below, I certify that all the above information given is true, and I recognize that any misrepresentation of facts will result in losing my privilege of adopting a pet. I hereby authorize release/disclosure of any records and/or other pertinent information including employment verification, proof of tenancy, and veterinary/personal references. I authorize my veterinarian permission to release any vet care records and information about my current and past pets to West Jersey Volunteers for Animals (WJVA). I understand that all animals adopted from WJVA have successfully passed a health and temperament screening and must be spayed or neutered before they are released from the rescue. Our Adoption Fees range from $150.00 for dogs 9 years and Older,
$250.00 for dogs up to 8 years old, and $300 for Puppies 10wks -5mon. Adoption fees cover: Spay/Neuter, Age Appropiate Vaccinations (Rabies,Distempter), Microchip identification, treatment for Heartworm if positive, Worming and Preventatives.
Electronic Signature *
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