Bandade Animal Rescue - Dog  Adoption Application
To ensure that this adoption is in the best interest of both you and the dog you selected, we ask that you complete this application.

Please be advised there is a $150 non-refundable adoption fee.
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Name of dog you are interested in adopting *
Your Name *
Home Phone *
Cell Phone
Full Address (street, city, state, zip code *
Email Address *
Type of Residence *
Own or Rent? *
What will happen to this dog if you move unexpectedly? *
What will happen to this dog when you go on vacation or in case of an emergency? *
How many hours during the average day will your dog be without a human? *
Where will this dog be kept during the day? *
Where will this dog be kept at night? *
Where will this dog be kept when you are not home? *
Do you want this dog to be (select one) *
Do you have a fenced yard? *
Please tell us why you would like to adopt a dog *
Please list below all the people your dog will be living with (including yourself): *
Name, Age, Relationship to prospective adopter
Is there any member of your household who is allergic to dogs? *
Are there any regular visitors to your home, human or animal, with which your new dog must get along?  If yes, please describe. *
Do you have any other pets living with you now?  If Yes, please list below *
Type (dog, cat, etc.), Breed,    Neutered/Spayed,       Owned for how long?
Have you had pets in the past?  If Yes, please list below *
Type (dog, cat, etc.), Breed,    Neutered/Spayed,       Owned for how long?,   Where is the pet now?
Do you have a regular veterinarian? *
If Yes, provide Clinic name, address, telephone number
May we have your permission to request information from your veterinarian? *
What kind of behavior do you find unacceptable, and if the dog has behavior problems, what will you do about it? *
By checking the box below, I certify that the above information is true and understand that false information may result in nullifying this adoption.  I also acknowledge that Bandade reserves the right to take the dog back if determined by Bandade to be in the dog's best interest.
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