SouthBARK Adoption Application

Thank you for your interest in adopting a SouthBARK dog. Completion of an adoption application is not a guarantee of approval. Your application will be reviewed by the adoption committee and may be rejected for any reason. Prior to approval of your application, a home visit will be completed by a member of the adoption committee to ensure it is a safe and loving environment.

Name of Dog *

Applicant *

First Name Last Name

Applicant Email *

Applicant Primary # *

Area Code Phone Number

Co-Applicant

First Name Last Name

Co-applicant Email

Co-applicant Primary #

Area Code Phone Number

Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Are you on Facebook? *

Yes No

Facebook Email

I live in a

I am a *

Renter Homeowner person living with others temporarily

Landlord's Name

First Name Last Name

Landlord's Phone #

Area Code Phone Number

Is your yard fenced? *

Yes No

Please describe fence:

How log have you lived at your current address?

Do you plan to move in the near future?

Yes No

Do you have children? *

Yes No

Please list names and ages of all children who live in the home at least 30% of the time.

Do you have other pets? *

Yes No

Please list all animals by name, gender and species

Are all pets spayed or neutered and up to date on vaccinations? *

Yes No

If not, please explain why.

Are your dogs current on heartworm prevention? *

yes no I don't have a dog.

Who is your current veterinarian? If you have no pets and therefore no veterinarian, please list a personal reference who does not live in your home. *

PLEASE READ THIS ENTIRE SECTION PRIOR TO SIGNING AND SUBMITTING YOUR APPLICATION.

We will be calling your veterinarian to confirm the above information. Please go ahead and call them to let them know it is ok to talk to a SouthBARK volunteer.

I understand that I am applying to adopt a SouthBARK dog. Once a SouthBARK dog, ALWAYS a SouthBARK dog. I understand that if I am unable to continue caring for the specified dog, I will contact SouthBARK and make arrangements to surrender him/her back to the rescue. I also understand that by signing below, I am releasing SouthBARK from responsibility for the medical needs of the specified dog upon completion of the adoption.

Electronic Signature (Full Name)

Enter the message as it's shown *