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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*

TRAINING CLASSES GROOMING BOARDING CATTERY LOCATION CONTACT ADOPTION DOGS

TRAINING
CLASSES
GROOMING
BOARDING
CATTERY
LOCATION
ADOPTION DOGS
CONTACT

4705 240th ST SE
Bothell, WA 98021

4705 240th ST SE
Bothell, WA 98021

425-486-9567 (phone)
425-486-9479 (fax)

425-486-9567 (phone)
425-486-9479 (fax)

Monday-Friday: 9AM-6PM

Saturday: 9AM-5PM

Sunday: By appointment only
Holiday Schedule

Monday-Friday: 9AM-6PM

Saturday: 9AM-5PM

Sunday: By appointment only
Holiday Schedule

© Academy of Canine Behavior 2018

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© Academy of Canine Behavior 2019