Adoption Application

Dog Adoption Form

Personal Information
Name*
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 Information
Other people, including children, in your household:
Name
Age
Relationship to you
Name
Age
Relationship to you
Name
Age
Relationship to you
Name
Age
Relationship to you
Home 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 dog
Are 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 EXPERIENCE
Do 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 Name
Is dog #2 sterilized?
- Yes
- No
Dog #2 Breed(s)
Dog #2 Age & Gender
Is dog #2 sterilized?
- Yes
- No
Dog #3 Name
Dog #3 Breed(s)
Dog #3 Age & Gender
Is dog #3 sterilized?
- Yes
- No
Dog #4 Name
Dog #4 Breed(s)
Dog #4 Age & Gender
Is dog #4 sterilized?
- Yes
- No
Please list any small animals, livestock, or horses on your property:
Please list any applicable dog experience you have:
REFERENCES
Please list contact information for your Veterinarian:
Name:
Phone
Please 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*