Adoption Application Dog Adoption Form Personal InformationName* First Last Phone*Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Are you the primary income earner in your household?* Yes No Your employer & your position*Name of primary income earner in your household:* First Last Primary income earner's employer & position:*Home InformationOther people, including children, in your household:NameAgeRelationship to youNameAgeRelationship to youNameAgeRelationship to youNameAgeRelationship to youHome Check*A home check is required for the adoption of our dogs, are you aware of this and can make your home available during business hours? Yes No What type of residence do you live in?* House Apartment Do you own your home, or rent?* Own Rent Do you have permission from your landlord to own a dog?* Yes No Landlord's name & contact information*Please list any breed and/or size restrictions:If you have a yard, please describe it:How many consecutive hours will the dog be left alone each day?*How will the dog be contained during this time?*Needs/Wants in a dogAre you applying for a specific dog?* Yes No Dog's name that you are applying for:*Would you be willing to consider a different dog if this one is unavailable?* Yes No What breed(s) or personalities do you prefer?*Indicate the physical characteristics of your ideal dog:*(Mark as many options as you like) Puppy (Less than 1 year) Young Adult (1-4 yrs) Adult (4-8 yrs) Senior (8 yrs plus) Male Female Toy (Under 10lbs) Small (10-20lbs) Medium (20-45lbs) Large (45-80lbs) Giant (Over 80lbs) Short Coat Medium Coat Long Coat Wire Coat Non-Shedding Other Other:Some dogs may have physical issues, indicate which ones your okay with:(Mark as many options as you like) Blind Deaf Diet Restrictions Seizures On Meds Comments:Indicate what you are looking to do with your ideal dog:*(Mark as many options as you like) Companionship Friend for Other Dog Playmate for Children Protection Therapy Service Dog Other Other:Indicate the behavioral characteristics of your ideal dog:*(Mark as many options as you like) Couch Potato Walking Partner Jogging Partner Marathon Runner Easy to Train Dog Park Playful Introvert Extrovert Most of our dogs have behavior issues. Indicate any quirks you are comfortable with: Aggression to Strangers Aggression to Dogs Aggression to Cats Fearful of Strangers Fearful of other Dogs On Leash Reactive PET OWNING EXPERIENCEDo you currently own any other pets?* Yes No Types of pets:* Dog Cat Reptile Bird Fish Other Other:*Dog #1 Name*Dog #1 Breed(s)*Dog #1 Age & Gender*Is dog #1 sterilized?* Yes No Dog #2 NameIs dog #2 sterilized? Yes No Dog #2 Breed(s)Dog #2 Age & GenderIs dog #2 sterilized? Yes No Dog #3 NameDog #3 Breed(s)Dog #3 Age & GenderIs dog #3 sterilized? Yes No Dog #4 NameDog #4 Breed(s)Dog #4 Age & GenderIs dog #4 sterilized? Yes No Please list any small animals, livestock, or horses on your property:Please list any applicable dog experience you have:REFERENCESPlease list contact information for your Veterinarian:Name:PhonePlease provide three personal references who we may contact about your suitability as a pet owner. At least two must be unrelated to you:Name* First Last Phone*Relationship to you*Name* First Last Phone*Relationship to you*Name* First Last Phone*Relationship to you*
