APPLICATION FOR DOG ADOPTION

NOTE:  ADOPTION FEE RANGES FROM $175.00 TO $225.00.  ALSO, PLEASE SEE OUR

ANIMAL PLACEMENT AND ADOPTION AGREEMENT

Date of application:_____________________________

Is there a specific dog from our web site you are interested in?_________________________________

Name:_________________________________________

Address:________________________________________

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How long at present address: ________________________

Phone:_______________________________________

Work Phone:__________________________________

Email address:_________________________________

#Of people in the household:_______________________

Ages of children:________________________________

Do you have contact with Grandchildren? ____  If yes, what are their ages? _________________

Do you have contact with neighborhood children? ____________ If yes, what their ages? ___________________________

Are you willing to attend dog obedience classes? _____________

Have you ever attended dog obedience training classes? ________

If your yard is not fenced, how do you plan on making sure your dog receives enough exercise? _______________

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Is everyone in your household in agreement on adopting a dog?________________________________

Does anyone in your household have allergies to dogs?____________________________________

Current pets in home / age / sex / spayed-neutered?

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History of prior pets (breed, how long did you have the pet, what happened to the pet?) Please describe in detail.

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Were your previous dogs protected against Heartworm? ___________ If no, why not? ___________________

Do you have a fenced yard?____________________ How tall?_____________________

If not, are you willing to fence your yard? _________

How would you describe your lifestyle (i.e.  retired, fulltime workers,  quiet, busy, etc.)

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HOUSING INFORMATION:

Do you own? ___________ Do you rent? ___________ Is it a house? ___________  Is it an apartment? ______

Is it a condo? ___________ 

If you rent , Landlord’s name:_____________________________________

Landlords address: _______________________________________________________ 

Landlord’s phone number: ______________________

What are you looking for in a dog?________________________________________________________

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Who will be the primary care giver of the dog?______________________________________________

How many hours per day will the dog spend alone?____________________________________________

What are the working hours of the adults in the household? ____________________________________

Where will the dog spend its days? If inside, where inside?

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Where will the dog sleep at night?_________________________________________________________

Would you accept a dog who is over 5 yrs old? ___________________

Would you accept a dog who has been abused? ___________________

Would you accept a dog that has a physical handicap? _____________

Are you willing to housebreak a dog if necessary? _______________

How will you handle adjustments/training problems such as barking? ______________________________

How will you handle adjustments/training problems such as chewing? ______________________________

Are you willing to give the dog at least two months to adjust to a new environment? _____________________

Certain breeds require to be groomed (approx. $45.00) about four weeks.  Does this present a problem?

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Will you agree to a home visit prior to placement of the dog?__________________________________

Additional Comments: _______________________________________________________________
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RFERENCES:

1)       Name:____________________________________________

Phone:____________________________________________

2)       Name:_____________________________________________

Phone:_____________________________________________

VET REFERENCE:

Name:_________________________________________________

Phone:_________________________________________________

List other rescues to which you have applied: ______________________________________________________
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I AGREE THAT ALL THE ABOVE INFORMATION IS CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE.

Signature of applicant:__________________________________________________________________