Adoption Application Name* First Last Email* D.O.B.* MM slash DD slash YYYY Spouse / Significant Other's Name First Last D.O.B.* MM slash DD slash YYYY List all others living in household, with agesAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneOccupation / How Long Name of Employer Spouse / Significant Other's Occupation / How Long Spouse / Significant Other's Name of Employer Veterinarian InformationVeterinarian's Name Vet Practice Name* Vet's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Vet's PhoneVet's FaxReferencesPlease 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 NamePlease 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Relative's PhoneDo 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 InformationI 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 petWhat 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 specificDuring 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 eventsWhat category best describes your household's scheduleWork at homeWork outside home, flexible scheduleRetiredFixed work scheduleHecticSomewhat hecticOrganizedSo organized its boringRealistically, 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 DetailsHave 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 termsDate* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
