Dog Adoption Application
We want to get to know you! Please fill out this preliminary application. An adoption Counselor will contact you. Please call 530-343-7917 X201
What Dog(s) are you interested in adopting? *
Your Name *
Phone Number *
Email *
Home Address (Street/City/State/ZIP) *
Emergency Contact for Microchip (other than yourself) *
Do You... *
Your home is a... *
Do you have a fenced in yard or patio? *
If you Rent, does your landlord allow pets?
Clear selection
If YES, how many pets are allowed?
Are there any breed restrictions?
Amount of pet deposit? If any, has it been paid?
Name of Landlord / Complex/ Park
Manager Phone Number
How many adults live in the home? *
How many children? Ages? *
Are any members of your household allergic to dogs? *
How will you handle interaction with the new dog and children?
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?) *
Please List any other pets you have previously owned as an adult (Type/Age/How long did you own? What happened?) *
Veterinarian's Name and Phone Number: *
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? *
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? *
How many hours will you dog be left alone without human contact on a typical day? *
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? *
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? *
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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