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DOG ADOPTION APPLICATION __________________________________________ Applicant's name_________________________________________________________ Local Address______________________________________________Apt#__________ City_________________________________State__________________Zip__________ Home Phone__________________________Work Phone___________________________ DESCRIPTION OF RESIDENCE:
Homeowners:
Do you have Homeowners Insurance?________________________________
Does your Homesowners Insurance have a breed specific clause?_____________
Name of Insurance Company?_________________________________
Phone Number?___________________________________________
House Property owner's name:____________________Phone____________
Renters:
Rental Property owner's name:____________________Phone____________ Do you live in a:
___Mobile-Home How long have you lived here?______________________________
___Duplex
___Apartment
Important: Will your Landlord / or property Owner object to your having a dog?___Yes ___No
Breed Specific?___Yes___No If specific, what Breed(s)__________________________
#Adults in house______#Children______Children's Ages_______ Who will be responsible for the dog?______________________________________
WHAT PETS DO YOU CURRENTLY HAVE IN YOUR HOUSEHOLD? KIND lSPAY/NEUTER l KEPT WHERE?l TIME OWNED l AGE Dog__Cat__ | Yes___No___ | In____Out___ |___________________|__________| Dog__Cat__ | Yes___No___ | In____Out___ |___________________|__________| Dog__Cat__ | Yes___No___ | In____Out___ |___________________|__________| Other______ | Yes___No___ | In____Out___ |___________________|__________| LIST PREVIOUS PETS WHAT HAPPENED KIND l SPAY/NEUTER l KEPT WHERE? l TIME OWNED l TO PET Dog__Cat__ | Yes___No___ | In____Out___ |_____________|__________________| Dog__Cat__ | Yes___No___ | In____Out___ |_____________|__________________| Dog__Cat__ | Yes___No___ | In____Out___ |_____________|__________________| Other______ | Yes___No___ | In____Out___ |_____________|__________________| ________________________________________________________________________ Are you at least 18 years old?______Yes_________No What is the name of your veterinarian?__________________________________ Veterinarian's address__________________________________________________ Who will financially support this dog?__________________________________ Reason for wanting this dog?____________________________________________ Where will you keep this dog?___________________________________________ Where will you keep this dog when you TRAVEL?___________________________ Do all members of this household want this dog?_________________________ How long will you give this dog to adjust to its new home?______________ How many hours will your dog spend alone?_______________________________ If you must give up this dog, what would you do with it?________________ Would you object to a follow-up home visit?______________________________ What amount of time will the dog be inside?______outside?______ If adopting an outside dog, do you have a dog house? ______Yes_____No If adopting an outside dog, do you have a fenced yard?_____Yes_____No If adopting an outside dog, do you have a shaded area?_____Yes_____No Are there any restrictions or BSL laws in your community?_____Yes____No
Are you willing to teach the children in your household the responsibility of having a pet?___Yes___No
Are you aware thet dog fighting is illegal?___Yes___No What do you want the dog for:(Check all that apply) ______Housepet________Breeder_______Fighting Dog ______Gift______________Gift for whom?______Company for other pet ______Watch Dog________Guard Dog __________Other(Please explain)___________________________________ Do you realize that you will probably have to housetrain your new puppy/dog? ____Yes____No Would you like information on how to housetrain a new puppy or dog? ____Yes____No If adopting an adult dog, how many times a day will you exercise it? ___________________________________________________________________ What form of exercise will you provide for your dog?_______________ __________________________________________________________________ What will you do if your dog shows other destructive behavior?__________________________________________________________ Do you intend to take your dog to obedience class?_________ Will you have your dog spayed or neutered within the recommended time frame? (A surgical operation to prevent parenthood for animals) ____Yes____No(explain)____________________________________________ What type of balanced nutrition do you intend to provide for your dog? ______________________________________________________________
Will you have this dog vaccinated annually, by a veterinarian, against infectious disease?______________________ Are you familiar with heartworm disease?______Yes______No Will you maintain your dog on heartworm preventative? _____Yes_____No Do you realize that dogs often live longer than 10 years and are you willing to assume responsibility for that long?______Yes_____No How will you keep the dog confined to your property?(Check all that apply) ___House____Kennel____Fence____Chain ___Patio_____Garage___Leash____Other
Will you allow home visits/check-ups?_____Yes___No If no,explain ____________________________________________________________
I certify the above is true and that false information may result in nullifying this adoption. I understand that no animal can be held for me unless this application is approved, and that adopted animals can be held no longer than 24 hours. I undestand that I am adopting a living being,and if I abuse the animal in anyway that the dog will be confiscated and immediately removed from my care by:_Rebecca Rinker. Signature___________________________________Date___________________ *We have the right to refuse adoption to anyone. *
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