Dog Adoption Application
We want to get to know you! Please fill out this preliminary application. An adoption Counselor will contact you. Please call 530-343-7919 X201
What Dog(s) are you interested in adopting? *
Your answer
You Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Home Address (Street/City/State/ZIP) *
Your answer
Emergency Contact for Microchip (other than yourself) *
Your answer
Do You... *
Your home is a... *
Do you have a fenced in yard or patio? *
If you Rent, does your landlord allow pets?
If YES, how many pets are allowed?
Your answer
Are there any breed restrictions?
Your answer
Amount of pet deposit? If any, has it been paid?
Your answer
Name of Landlord / Complex/ Park
Your answer
Manager Phone Number
Your answer
How many adults live in the home? *
Your answer
How many children? Ages? *
Your answer
Are any members of your household allergic to dogs? *
How will you handle interaction with the new dog and children?
Your answer
Are you... *
How many pets live in the home? *
Please list the pets currently living in your home (Type/Age/Spayed and Neutered? Current of Vaccines?) *
Your answer
Please List any other pets you have previously owned as an adult (Type/Age/How long did you own? What happened?) *
Your answer
Veterinarian's Name and Phone Number: *
Your answer
What are you looking for in a new dog? *
My new dog needs to get along with other dogs *
My new dog needs to get along with cats *
I am looking for a dog that is... (check all that apply) *
Required
I am looking for a dog that is... (check all that apply) *
Required
Check any of the following reasons for adopting a dog *
Required
Will this dog be a surprise for anyone? Who? *
Your answer
Is everyone in the in favor of adopting a new pet? *
Required
Who will be responsible for the daily care of the new dog? *
Required
How much do you expect to spend annually on vet care for your dog? *
Required
If your dog develops an expensive medical problem, what would you do? *
Your answer
How many hours will you dog be left alone without human contact on a typical day? *
Your answer
Will this dog live... *
Required
Where will the new dog stay when you are not home? *
Required
If your new dog needs further house training, what methods will you use? *
Required
Which circumstances justify giving up a dog? Check all that apply... *
Required
What will you do with the dog if one of these should arise? *
Your answer
The annual cost of a dog may range from $500 to $3,000. If your dog develops an expensive medical problem, what would you do? *
Your answer
Has there ever been a dog that was exposed to or diagnosed with Parvo Virus in the last 8 years at the residence the ne wdog will be living? *
Required
Butte County has some of the highest heartworm rates in the state. Are you familiar with heartworm disease and how it affects dogs? *
Required
We hope that you are your new dog have a long and healthy life ahead of you. Are you prepared to provide a permanent loving home for this dog for the next 10-15 years? *
Required
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