Adoption Application - Dog

If you are interested in adopting one of our dogs, please fill out the form below and we will be in contact with you!

Name:
Address
City, State, Zip	,
Telephone Number
E-mail Address
Age (If under 21)
Name of Pet you wish to adopt

1.	1. How long have you lived at this address? years months
2.	Do you rent your home or live in a trailer park? Yes No If yes, we need to confirm that you are allowed to own a pet. Please complete the following information in full. Landlord's Name Landlord's Phone Landlord's Address
3.	Are you a college student? Yes No Do you live on campus? Yes No If yes, whom should we contact to confirm that you are allowed to keep a dog? Contact's Name Contact's Phone Contact's Address
4.	Do you have young children living with you? Yes No If so, how old are they?
5.	Are you presently employed? Yes No Retired
6.	Is your partner presently employed? Yes No Retired
7.	Have you adopted a pet from a rescue group or shelter before? Yes No If so, how many?
8.	Have you ever surrendered any pet(s) to a rescue group or shelter? Yes No - If so, why?
9.	Do you have any pets at this time? Yes No If so, how many? Please list their names and what kind of pet
10.	Do you keep your pet(s) up-to-date on vaccines, as recommended by your veterinarian? Yes No Not Applicable
11.	Are your pets spayed or neutered? Yes No
12.	Do you give your permission for us to confirm your answers to questions 10 and 11? Yes No Not Applicable If yes, your vet's name is? Practice Name Phone
13.	How many hours, on average, will your dog be alone?
14.	Where will your dog be kept in your absence? In a crate In one room Run of the house Outside
15.	Where will your new dog sleep at night? In a crate In one room Run of the house Outside
16.	Will you be able to proved regular exercise for your new dog? Yes No If yes, how often? Daily Several times per week Once per week
17.	Do you have a fenced yard? Yes No If not, do you intend to use a tie-out or other means of securing your dog safely outside? Yes No
18.	Are you familiar with State laws concerning pet ownership, with regard to licensing, valid rabies vaccination, leash laws and roaming? Yes No If not, would you like to receive information? Yes No
19.	Do you understand what vaccinations and other health care your new dog will require each year? Yes No
20.	Do you agree to take your pet to a veterinarian every 12 months to receive an annual check up and booster shots? Yes No
21.	Do you agree to take your pet to a veterinarian as soon as possible if he/she is sick or injured? Yes No
22.	Are you familiar with heartworm control and flea prevention? Yes No If not, would you like to receive information? Yes No Would you be willing to provide monthly heartworm care for your dog? Yes No
23.	Do you understand the particulars of daily care for your new pet, including food, water, shelter, grooming, training and exercise? Yes No
24.	Have you considered care for you dog while you are away? Yes No
25.	What is the reason for adopting a new dog? Companionship Protection Sport
26.	Do you agree to kiss your new dog on the nose at least once a day? Yes No
I certify that the facts in this application are true and complete; and understand that falsified statements on this application shall terminate the adoption process.