Adoption Saves Lives *for better usability, open in your web browser APPLY! Who are you interested in adopting? Name * First Name Last Name Phone (###) ### #### Email * Your date of birth MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Type of Home House Apartment Townhouse Mobile Home Other Name of your landlord First Name Last Name Phone number of your landlord (###) ### #### Do you rent or own? Rent Own Do you have a fenced in yard? Yes No Employeer Employers Name First Name Last Name Employers Phone Number (###) ### #### Why are you wanting to adopt? Have you ever owned a pet before? Yes No Have you ever had to re-home/surrender/give away a pet before? If yes, why? Do you currently have any pets at home? Yes No Please tell me about your pet(s) Breed - Age - Species - Demeanor - etc. Are your current pet(s) spayed/neutered Yes No Are your current pet(s) up to date on all vacines and preventitives? Yes No Name of current Vet Clinic Phone number of Vet Clinic We will be contacting. (###) ### #### Personal Reference First Name Last Name Relation to you? Reference phone number (###) ### #### Please describe the type of life the dog would have with you. Would it live inside? How long would it be left alone? Would it travel with you? Where would it sleep? Please list and describe who lives with you. Relation and age (children too!) How active is your lifestyle? Sedentary Moderately Active Very Active What qualities are you looking for in a dog companion? Are you prepared for the financial responsibilities of pet ownership, including veterinary care, food, and supplies Yes No Are you willing to provide regular veterinary care, including vaccinations and preventive medication Yes No How do you plan to exercise and socialize your new dog? Are you willing and able to care for this animal its entire life which could be as much as 15 years? Yes No I understand that I am required to pay an adoption fee and sign a contract for care. Yes No Thank you!
