Adoption Form

What is your name?*
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Best Phone to Reach You*
Your Age*
Please enter a number from 1 to 150.
Co-Applicant's Name
First Last
Co-Applicant's Age
Please enter a number from 0 to 150.
Dog type or name

Is there a specific dog type or a particular dog that you're interested in learning more about? If so please enter the type of dog or the dog's name here.
Please describe your housing*
Please describe "other" housing*
Landlord's Name*
Name
Enter landlord's first and last name or name of company you rent from.
Landlord's Phone
Years at present address?*
Please enter a number from 0 to 100.
For twenty three months or less, enter zero or one (0 or 1).
Previous Address*
Street Address Address Line 2 City State ZIP Code

List each child's name and age*

Name	Age

List all children who live with you part or full time. If NONE enter NONE on first line.

All other household members*

Name	Age	Relationship to You

List all other members of your household who live with you even one day a year or more. If NONE enter NONE on first line.

Do you have a fenced yard for your dog?*
Please note that electric fences use electric shock to punish your dog into staying put. They are inhumane.
Have you ever owned a pet?*
- Dog
- Cat
- Bird
- Fish
- Reptile
- Small and furry
- Horse
- Other
- I've never owned a pet

What happened to your past pets?*

Name	Species	Lost? Died? How?

How did your pets leave you? If this question doesn't apply put NA in the first line.

List all pets who will live in same home as the dog*

Name	Species

If the dog will be the only animal enter NA on the first line.

Your CURRENT Vet's Name and Clinic Name*

If you don't have a CURRENT vet enter NA.
Vet's Phone*
Your Pets at CURRENT Vet's Office*

List the names of animals your current vet has treated.
PREVIOUS Your Vet's Name*

If you don't have a PREVIOUS vet enter NA.
PREVIOUS Vet's Phone*
Pet's Names at Previous Vet's*

List the names of pets your previous vet treated
Why do you want to bring a new pet into your home?*
Is everyone in your household in agreement about getting a new pet?
Who is having doubts and why?*
Where will this pet spend most of its time?*
Where will the pet spend most of its time?*
Who is home during the day and when?*
Who is home during the evening and night and when?*
What provisions will be made for your pet when no one is home?*
What provisions will be made when you go on vacation?*
Are you willing to provide training for your pet (obedience, housetraining)*
Do you know of a trainer or place that provides training in your area?*
Are you planning on particular activities with your pet? Please explain.*
If you are adopting a dog, are you planning for it to be a guard dog?*
How much do you believe a pet costs per year?*
Under what circumstances would you give up your pet?*
Do you have any questions or comments?
Do you agree to a home visit before and after adoption?
- Yes
- No
- Please give me more information
Phone
This field is for validation purposes and should be left unchanged.

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