Adoption Application in Phoenix, AZ | Deer Creek Animal Hospital

Name*
First Last
Email*
D.O.B.*
Date Format: MM slash DD slash YYYY
Spouse / Significant Other's Name
First Last
D.O.B.*
Date Format: MM slash DD slash YYYY
List all others living in household, with ages
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone
Cell Phone
Occupation / How Long
Name of Employer
Spouse / Significant Other's Occupation / How Long
Spouse / Significant Other's Name of Employer
Veterinarian Information
Veterinarian's Name
Vet Practice Name*
Vet's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Vet's Phone
Vet's Fax
References
Please provide info on two individuals not related to you who can serve as references.
Name (Reference 1)
First Last
Phone (Reference 1)*
Name (Reference 2)
First Last
Phone (Reference 2)*
Relative's Name
Please provide the name, address and phone # of your nearest living relative
First Last
Relative's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relative's Phone
Do you own or rent your home?
- Own
- Rent
How long have you lived at your current address?
If renting, do you have your landlord's permission to keep dogs?
- Yes
- No
- N/A
Can you provide us with such permission in writing?
- Yes
- No
- N/A
Adoption Information
I am interested in (Choose all that apply)
Fostering is a good way to find out if you really want to live with a pet.
- Adopting
- Fostering
May we visit your home and check the references to verify the information you have provided
- Yes
- No
List the pets you've owned in the past 7 years. (Past & Present, leave blank if none)
Please list names, ages, health of each living pet, breed, and how many you have currently. Cause of death for deceased pets.
Are current pets spayed or neutered? If not, why?
Why do you want a pet?
Is everyone in your home agreeable to getting a pet?
- Yes
- No
Is anyone in your household allergic to dogs?
- Yes
- No
Have you ever owned a dog before?
- Yes
- No
How have you educated yourself about this dog?
What is your philosophy regarding pets and children?
Describe the grooming care you would provide for your pet
What do you anticipate the cost will be to provide basic care for your dog?
Including Grooming, Vet care, supplies, dental cleanings, food, license, toys and bed
- $100/Year
- $500/Year
- More than $500/Year
What do you plan to feed your pet?
Be specific about the brand.
Are you willing to change?
- Yes
- No
Dog(s) interested in: *
Please list the dog's name (if known) or characteristics of pet you are interested in.
Please list your preference regarding gender
- Male
- Female
- No Preference
Please list your preference regarding Age
- Less than 2 years
- 2-5 years
- Over 5 years
- No preference
Would you consider a special needs dog?
- Yes
- No
- Maybe
Will you consider something other than your stated preference?
- Yes
- No
Where will you keep your dog?
Please be specific
During the day?
- Crated
- Free to roam inside
- Free to roam outside
- Free to roam with dog door
During the night?
- Crated
- Free to roam inside
- Free to roam outside
- Free to roam with dog door
During vacations or while you are away overnight
- Pet sitter
- At vets
- Leave with friend
- Boarded
- Crated
- Free to roam inside
- Free to roam outside
Do you have a safe and securely fenced yard (well maintained: no loose boards, no gaps, holes or protruding nails)?
- Yes
- No
How large is the area that is fenced?
- Patio
- Less than 200sq ft
- Small (10ft x 30ft)
- Medium (20ft x 40ft)
- Large (60ft x 100ft)
- 1/2 Acre
- Over 1/2 Acre
- N/A
What type of fencing do you have and how high is it?
Type, height, gate?, dog door?
If you do not have a fenced yard, how do you plan to exercise your dog?
Do you have a pool? Is it fenced?
How often and how long will you walk your dog?
If you are gone from the home on a daily basis, give a breakdown of your daily routine including sleep, work, meetings, errands, eating out, school functions and any other regularly scheduled events
What category best describes your household's schedule
Realistically, how many hours a day will you spend with your dog (excluding sleep)?
Are you able to come home in the middle of the day to walk the dog and/or give it a chance to relieve itself?
- Yes
- No
What is the maximum number of hours your dog will be left alone during a 24 hour period?
How many of these hours will the dog be confined without a chance to relieve itself?
Where will the dog spend this time (please be specific)
When you are away from home, will your dog have companionship?
What will you do if your dog is destructive when left alone?
Are you willing to attend obedience classes with your dog?
- Yes
- No
Have you ever trained a dog before?
- Yes
- No
Have you ever surrendered a pet of yours to an animal shelter?
- Yes
- No
If Yes, why? Give Details
Have you ever sold or given away a pet?
- Yes
- No
To whom, why?
What circumstances, in your mind, justify giving up/relinquishing a dog?
What circumstances justify euthanizing a dog?
Agree to Proceed
Thank you for taking the time to complete this application. By entering your name below, you attest to the truthfulness of your answers, and agree that we may verify any part, or all of your answers contained in the application, and may take any other investigative steps necessary to ensure the adoption applicant(s) is/are suited to adopt a dog. Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog.
Signature*
I agree to the above terms
Date*
Date Format: MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

Veterinarian Information

References

Adoption Information