Adoption Application Form

Please note: All dogs will be spayed or neutered prior to placement.
 

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Your Details
Full Name:
Title: mr/mrs/miss/ms
Street Address:
Address (cont.)
City:
State:
Zip Code:
Work Phone#: please include area code
Home Phone#: please include area code
Cell Phone#:
Email Address:
Date of birth: mm/dd/yyyy
Gender: male/female
Martial Status: married/living with partner/single
Spouse Full Name:
Spouse Date of birth: mm/dd/yyyy

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About the dog
Please provide the name of the dog you are interested to adopt:
   
Do you prefer Male or Female?
Do you prefer an adult or puppy?
Dog's living situation: Indoor?
Dog's living situation: Outdoor?
Where will the dog be when you are not home?
How many hours a day will the dog be home alone?
How will you exercise the dog?

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Where You Live
What is your yard size?
Is the yard enclosed by a fence? yes/no
Please explain the type and size of fence:
What type of home do you live in? house/apartment/etc
Do you own the property? yes/no
If you are renting please verify the landlord's name and phone number for verification:
Home Location: city/suburban/rural/etc
Does your municipality have breed specific restrictions? yes/no/don't know
If so, please describe the nature of the restrictions:

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People At Home
How many individuals over 21 in your household?
What are the ages of the individuals over 21?
How many individuals under 21 in your household?
What are the ages of the individuals under 21?
Are there plans of adding children to the family in the future?

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Pets
Do you have other dogs?  If answering yes, please specify how many you have:
What are their sexes?
How many are spayed or neutered:
Please specify breeds and ages of the other dog/s:
If you had other dogs in the past, please let us know the current deposition of those dogs.
What other kind of animals do you own?
Please relate any prior experience you have had with the breed of dog you wish to adopt:
Have you checked with your homeowners insurance company to see if they have any dog breed restrictions?

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Additional Details
Please supply two personal references their name, address and phone number (anyone not related to you who can attest to your character): reference 1
reference 2
   
Please supply your current veterinarian details, veterinarian name, clinic name, address and phone number:

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And Finally
Any additional information you would like to provide: