Adoption Application

Adoption Application

Name
Home Phone
Work Phone
Email address
Occupation
Home Address 1
Address 2
City
State
Zip
Years at address
Months at address
Do you rent or own?	Rent Own
If you rent, do you have landlord's permission to have a pet?	Yes No
Please provide landlord's contact information: Name:
Landlord's phone number
Do you have a fenced in back yard?	Yes No
Is it attached to the house?	Yes No
Do you have a pool?	Yes No
May we visit your home?	Yes No
When?
Do you have children? If yes - how old?
Are you planning on having children?	Yes No
Are there any other people in your household?	Yes No
Do you or anyone living in the house have any allergies?	Yes No
Who would the dog be for (primary caretaker of dog)?
Why do you want a dog?
Which dog are you interested in?
Do you have a second choice?
If no specific dog, do you have a breed preference?
Gender preference?	Male Female
Would you accept a mixed breed?	Yes No
Would you take a dog with special needs?	Yes No
Are you planning to crate train?	Yes No
How are you planning to exercise the dog?
Please provide us with some information about your lifestyle:
Where would the dog be kept during the day?
Where would the dog be at night?
Where would the dog stay if you go on vacation?
If you have to move, what would happen to the dog?
Are there any behaviors for which you would give up the dog?
Do you have other pets?	Yes No
Number of dogs? Names?
Number of cats? Names
Other pets?
Are they all current on all vaccines and heartworm prevention?	Yes No
If you have pets, please provide us with your veterinarian:
Veterinarians phone number?
Do we have your permission to contact your veterinarian if appli	Yes No
Do we have your permission to contact your landlord if applicabl	Yes No
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