ADOPTION FORM

Which dog are you interested in?

Are you looking to adopt immediately or within a few weeks?
Immediately Within A Few Weeks

PERSONAL INFORMATION

Name:
Email:
Address:
City: State: Zip Code:
Occupation:
Day Phone: - -
Evening Phone: - -

REFERENCES

Please provide the contact information of a veterinarian you have used before and plan to use with your new dog? Vet references are checked.

Vet Information:

Vet Name:
Vet Phone: - -
Vet Address:
Vet records are under the name of:

Please provide the names, their relationship to you and phone numbers of two people you know and who know you (no family members):

First Reference:

Name:
Phone: - -

Second Reference:

Name:
Phone: - -

Please list place of employment for yourself and your spouse, if applicable.
Self:
Employment Name:
Employment Address
Employment Phone:
Spouse:
Spouse Name:
Employment Name:
Employment Address:
Employment Phone:

HOUSEHOLD INFORMATION

Residence:
Where do you live:
If other please specify:

Do you own or rent? If you rent please answer the following:
Is the lease in your name?
Yes No
(you must provide your landlord's contact information so that we may verify that you are allowed a pet.)
How long have you lived at this location?
What floor do you live on?
Do you have a terrace?
Yes No
Are you moving in the near future?
Yes No
If yes please explain.

List below all people who currently live at this residence: Name, Relation to You, Age:
Does anyone in your house have any known allergies to dogs or asthma?
List below any cats, dogs, birds, etc. who currently live in your household: Name, Type/Breed, Age, Sex/Neutered, How long Owned,
If you have a cat is it declawed?:
Yes No

HISTORY

Have you owned a dog before?
Yes No

(If Yes, please provide us with a brief history of what happened to it).

If your last dog died, please answer the following questions:
Name:

Date Deceased:

Cause of Death:

Have you owned an artic breed before?
Yes No
If so, explain.

Have you ever taken one of your pets to a shelter?
Yes No
If yes please describe circumstances.

CARE OF THE DOG

Do you have a fenced area on your property?
Yes No

Is the area completely fenced in?
Yes No

If yes, how high is the fence and approx how large is the fenced in area?

What kind of fencing is it?

Is the fencing buried beneath ground level?
Yes No

If you have no fence, how do you plan to have your new dog relieve/exercise itself?
Walk On Leash Walk Off leash Enclosed Dog Run

How active is your lifestyle aside from work? Please explain?

Do you actively jog, or ride a bike?
Jog Ride Bike

Do all adults work full time?
Yes No

How many hours each day will your new dog be alone?

How many hours each day will you spend time with your dog?

Where will your new dog be kept when it is alone? be specific

Where will your new dog be kept during the day? be specific

Where will your new dog sleep? be specific

What sort of training do you plan on providing the dog?
Professional Trainer Train Myself Friend None

DONATION

We request a donation and depending on the expenses incurred in the dog's rescue and veterinary care this fee varies. All animals are spayed/neutered prior to placement. Is this acceptable?
Yes No

Please realize that dogs need vet care throughout their lives, including yearly boosters, heartworm and flea/tick preventative meds, etc. If you cannot afford a donation, can you afford the appropriate vet care?
Yes No
Please consider that the adoption procedure includes a visit to your home prior to adopting the animal and one or more follow-up visits. Is this acceptable?
Yes No

If these terms acceptable to you, please indicate by typing below:

Print name: