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Adoption Application
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* Indicates required question
Date
MM
/
DD
/
YYYY
Name of the Dog you are interested in
*
Your answer
Where did you hear about the dog
Your answer
Name
*
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Email Address
Your answer
Preferred Contact Method
Your answer
I am 21 years of age or older
*
Yes
No
Required
Housing Information
Do you rent or own
*
Rent
Own
Required
If renting, what is the policy on allowing pets
Your answer
Is there a deposit fee for pets
Your answer
Is there a weight or breed restriction for pets
Your answer
May we contact your landlord
Your answer
Landlord’s Name
Your answer
Landlord’s Phone No.
Your answer
Do you have a fenced in yard
Your answer
If yes, what type and how high
Your answer
Do you have children in your home
Your answer
If yes, how many and the age of each child
Your answer
Do your children understand the responsibilities of caring for animals
Your answer
Current/Past Pet Information
Do you currently own any pets
Your answer
If no, have you owned any pets in the last four year
Your answer
Please list the name, breed and age of your current or pets in the last 4 years
Your answer
Are the vaccinations current for your pets
Your answer
Date of Expiration
Your answer
Are your pets on heartworm preventative
Your answer
Name of the preventative
Your answer
Are your pets spayed/neutered
Your answer
If no, please explain why
Your answer
May we contact your Veterinarian
Your answer
Veterinarian Name
Your answer
Veterinarian’s Phone Number
Your answer
New Pet Information
Do you understand the history of the dog you are adopting
Your answer
How much time will the dog spend alone
Your answer
How many hours per day will the dog be alone
Your answer
When no one is home, where will you keep the dog
Your answer
Where will the dog sleep at night
Your answer
Are you prepared to spend from 150.00 to 300.00 per year in veterinary fees for routine shots and preventative medicines, such as frontline, heartguard, etc.
Your answer
How much time are you and your family prepared to spend with the adopted dog
Your answer
In case you experience a life change, such as a move, a divorce or a new baby, how will this affect the adopted animal
Your answer
Do you understand that adopting a pet is a commitment for the animal's entire lifetime and are you willing to accept that responsibility
Your answer
May we visit your home
Your answer
Personal References
First Reference
*
Your answer
First Reference Phone Number
*
Your answer
Second Reference
*
Your answer
Second Reference Phone Number
*
Your answer
Do you agree to the above terms
*
Yes
No
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