аЯрЁБс>ўџ -/ўџџџ,џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС7 №П…bjbjUU "&7|7|…џџџџџџlфффффффјіііі  јё Ж""""""""p r r r r r r $Ї Ч– ф"""""– фф""Ћ "Жф"ф"p "p \p ффp " %” PХјўіи6p p С 0ё p ззp јјффффйDogs Name: Fee: $75 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. *  CKdeЙвгдпр!"lmЈЉст#$,-‚ЬЭжзфх?@ J K L ’ Й Ы ђ K №о№Я№Я№О№ЯЊ–№Я№Я№Я№Я№ЯЊ–№Я№Я№Я№Я№Я№Я№О‡№v№О‡№v >*B* CJOJQJ^JaJph€B* CJOJQJ^JaJph€&5>*B* CJ$OJQJ\^JaJ$ph€&5>*B* CJOJQJ\^JaJph€ >*B* CJOJQJ^JaJph€B* CJ$OJQJ^JaJ$ph€#5B* CJOJQJ\^JaJph€B* CJOJQJ^JaJph€.Lдр"mЉт$-‚Эзх@ uмтэk„…§§§§§§§§§§§§§§§§§§§§§јі$a$…ўK tuлмьэjkƒ„…№с№с№с№с№см B* ph€B* CJ$OJQJ^JaJ$ph€B* CJOJQJ^JaJph€ 1hАа/ Ар=!А"А# $ %А i8@ёџ8 NormalCJ_HaJmH sH tH <A@ђџЁ< Default Paragraph Font:^@ђ: Normal (Web)ЄdЄd[$\$…&џџџџLдр"mЉт$-‚Эзх@u м тэk„‡˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€K ………t—,7љEc/9FZ›П\apw“› ЈЎЗмфщёї%-2:@I|„Š“LTYagp—ŸЄЌВЛтъяї§;CIRнѕ? S –   в ц  , \ t Ь л ъ ю џ Ms~”™ЋЦжpyТЫ%sŒШвBWІЧЫь#-aj‡ї‡ F^`†ˆЕЗ§џIK­Џ24NPяёuw+,ж и Я б zЬЮˆŠ#&;=FHŒRT‡3333333333333333333333333 KQ]ikvwƒtuЬђ*,8CЫЭ67bdстйкћ „‡џџbecca:C:\Documents and Settings\becca\My Documents\Adopt App.docHLOaC:\Documents and Settings\Hank\Application Data\Microsoft\Word\AutoRecovery save of Adopt App.asdHLOD:\becca docs\Adopt App.docHLOD:\becca docs\Adopt App.docHLOD:\becca docs\Adopt App.docHLOMC:\Documents and Settings\Hank\My Documents\My Pictures\Becca's\Adopt App.docHLOMC:\Documents and Settings\Hank\My Documents\My Pictures\Becca's\Adopt App.docџ@€QQь–AŒQQ…@@џџUnknownџџџџџџџџџџџџG‡z €џTimes New Roman5€Symbol3& ‡z €џArial"qˆ№аhЛ‚Fš•Ffd )!№ ДД20а2ƒ№џџkRecord #___________ Dogs Name_____________beccaHLOўџр…ŸђљOhЋ‘+'Гй0Ь˜ (4@T `l ˆ ”  ЌДМФфlRecord #___________ Dogs Name_____________ecobecca #eccecc Normal.dot_HLO6OMicrosoft Word 9.0 @еЁ@’RAfъУ@l,Ž PХfdўџеЭеœ.“—+,љЎ0T hp|„Œ” œЄЌД М 4фd) а  lRecord #___________ Dogs Name_____________ Title ўџџџўџџџ !"#ўџџџ%&'()*+ўџџџ§џџџ.ўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РF A1” PХ0€1TableџџџџџџџџџџџџWordDocumentџџџџџџџџ"&SummaryInformation(џџџџDocumentSummaryInformation8џџџџџџџџџџџџ$CompObjџџџџjObjectPoolџџџџџџџџџџџџ A1” PХ A1” PХџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Word Document MSWordDocWord.Document.8є9Вq
Make your own free website on Tripod.com