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Wanting to Adopt (name of pet) *
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My Name Is *
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Spouse Name *
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Street Address *
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City *
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State *
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Zip Code *
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Home Phone *
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Alternate Phone *
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eMail Address
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Type of Dwelling *
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If Other, Explain *
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Do you Own or Rent *
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If renting, landlord's name *
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Landlord Address & Phone *
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How Many Adults in the Household *
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How Many Children *
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Children's Ages *
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Who Will Be Responsible to Care for This Pet? *
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Do All Members of Your Household Want a Dog? *
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Is this your First dog? *
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Do You Have Other Pets? *
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Types and How Many? *
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Are These Pets Spayed or Neutered?
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Have you EVER had to give up a pet? *
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If Yes, Please Explain *
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Will you provide monthly heartworm preventative? *
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Will you provide required vaccinations? *
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Have you EVER had a pet die of Heartworm, Distemper, Parvo or Rabies? *
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If Yes, Please Explain
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Name of Vet Clinic *
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Vet Address & Phone *
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Do you have a Fenced Yard? *
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Type of Fence? *
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Height? *
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Do you have a Pool? *
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Where will dog be kept during the day? *
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Hours Dog will be Alone? *
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When alone, where will dog be kept? *
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Where will dog be kept at night? *
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Where will dog sleep? *
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Will dog be permanently outdoors? *
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Will you seek training for this dog? *
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What behaviors will you not tolerate? *
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What event/activity would make you return this dog? *
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If adopting a PUPPY, are you aware of the behaviors and energy a puppy brings into the househouse? *
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If you are unable to be home due to vacation, travel, emergency situations - who will care for this pet? *
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Do you understand you will be sharing your life with a dog for 10-15 years, who is totally dependent upon you for food, shelter, veterinary care and affection? Are you willing and able to make this life-long commitment to a dog as a family member?
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Additional information you would like us to know?
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ALL
adopters require a home visit before final approval of the
adoption.
We want to ensure our rescues
are being placed in an environment that is most beneficial to each
specific dog.
If you decline a home visit, your adoption request could be
terminated.
I
understand there is an adoption fee that is collected for all
adoptions to defer costs for the care and medical treatment of
adoptable dogs & puppies.
I
believe the answers above are true and correct.
If the information provided is found to be false or misleading, I
understand my application will be declined.
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