Dog Adoption Form
Your Full Name:
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First Name
Last Name
Your Age:
*
Your Spouses Full Name:
*
First Name
Last Name
Your Spouses Age:
*
Full Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone:
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-
Area Code
Phone Number
Work Phone:
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-
Area Code
Phone Number
Email:
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example@example.com
Which animal are you applying for?
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Employer:
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Spouse’s Employer:
*
Ages of children:
*
Is everyone in the household in agreement about adopting a dog?
*
Yes
No
Name of homeowners insurance agent/company:
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Homeowners insurance agent/company Phone number:
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Current living situation:
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Condo
Apartment
Mobile Home
House
Do you:
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Rent
Own
If rent, Landlord Name:
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If rent, Landlord Phone:
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Besides immediate family are other residing in your home?
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Yes
No
If others are living in your home besides immediate family please give details,including names and ages:
*
Does your home have a yard?
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Yes
No
If Yes, is it fenced?
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Yes
No
Type of fence and height:
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Is fence secured underground?
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Yes
No
Is fence secured with a padlock?
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Yes
No
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Adoption Information
Is someone home during the day?
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Yes
No
If no, where will the dog stay?
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Where will your dog be kept most of the time?
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If outside, will you have a dog run/house?
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Yes
No
Please give details:
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Where will your dog sleep at night?
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Will you take the dog to obedience classes?
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Yes
No
How do you feel about crating your dog?
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Have you ever owned a dog?
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Yes
No
If yes, where is that dog now?
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Prefer:
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Male
Female
Age range preferred?
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Baby
Young
Adult
Senior
Why do you want a dog?
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Use for guard dog?
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Yes
No
Years you plan on keeping dog?
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What activities do you plan on enjoying with your dog?
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What type of traits are you looking for in a dog?
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Energetic
Couch potato
Jogging buddy
Calm
Play ball
Camping buddy
Social butterfly
Clown
Serene
Able to take to work
What training methods would you use?
*
Would you ever consider an electric fence?
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Where would you take your dog for training?
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If you went out of town, where would the dog stay?
*
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Other Pet Information
Do you own other pets?
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Yes
No
Other pet type? Type, Age, Sex, Breed.
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Are all pets spayed/neutered?
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Yes
No
Are all pets vaccinated?
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Yes
No
Are all pets on Heartworm prevention?
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Yes
No
If yes, What type?
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Willing to pay for heartworm test?
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Yes
No
Veterinarian:
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Veterinarian Phone:
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If you have current pets and veterinarian office, please list pet’s name and owner’s name (on record at vet’s office):
*
If applicable, when was your current pets last visit?
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List all pets you have had in the past 10 years and what happened to them:
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List any Humane Societies, organizations, breed or training clubs you are associated with:
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Please list three references:
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Submit
Should be Empty: