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DOG ADOPTION
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First Name
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Last Name
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Address
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City
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State
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Zip Code
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Age
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Your Occupation
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Phone Number
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Email Address
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Who are you interested in adopting?
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Name of spouse/significant other?
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Significant other/spouse's occupation?
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Do you have any children? If yes, please list age
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Do you have any roommates? If yes, please list name and age
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Is everyone in the household aware you are interested in adopting a dog?
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Does anyone have pet allergies in your home?
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Who will be responsible for the dog?
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Are you aware dog can live 15-20 years and are willing to take on this responsibility?
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Why do you want to adopt a dog?
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Is this dog a gift? If yes, please explain
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This dog will be a… (Check all that apply)
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Companion
Companion for another pet
Protection
For child
What type of home do you live in?
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Single family home
Single family home
Townhome
Apartment
Condo
Do you rent or own your home?
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Rent
Rent
Own
How long have you lived at this address?
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Do you have plans of moving in the future?
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Yes
Yes
No
If you rent, are dogs allowed?
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Yes
Yes
No
N/A
If you rent, please list the name and contact information of your landlord
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In what areas of your home will your dog be allowed?
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When you are not home, where will the dog be kept?
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How will they be kept?
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Crate
Run of the house
Backyard
Kennel
Access to doggie door
Dog house
Garage
Other
Do you have a yard?
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Yes
Yes
No
What type of fence?
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How tall is your fence?
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Does the fence fully enclose the yard?
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Yes
Yes
No
If you do not have a fenced yard, how will your dog be let out?
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Do you have a pool?
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Yes
Yes
No
If you have a pool, will dog be left unattended around the pool?
Yes
Yes
No
If you have a pool, what will you do to ensure the dog’s safety?
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Do you have screens on your windows?
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Yes
Yes
No
How many hours will your dog be left alone? Please include hours during the pandemic and after
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Is this your first pet?
Yes
Yes
No
Where will your dog sleep?
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What type of lifestyle do you have?
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Sedentary
Sedentary
Moderately active
Very active
What activities will you do with your dog?
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Are you familiar with the breed you are interested in adopting?
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Do you currently have any pets? If so, please list name, breed, and age of all pets
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Do your current pets live indoor, outdoor, or both? Please list each pet
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Are your pets current on their vaccinations?
Yes
Yes
No
N/A
Are your current current pets fixed?
Yes
Yes
No
N/A
Will you keep your dog up-to-date on vaccines?
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Yes
Yes
No
Have you had pets in the past? If so, please list name, breed, age and why you no longer have them
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If applying for a puppy, have you raised a puppy before?
Were you ever in a situation you could not keep your pet? If so, please explain
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In the event you are no longer able to care for your dog, who will be responsible for their care? Please include name, relationship, and contact information
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What kind of food will you feed your dog? Please include brand
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What precautions will you take when introducing the new dog to your current pets?
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Are you okay with a home check
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Yes
Yes
No
Name of Veterinarian
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Veterinarian’s Phone
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Veterinarian’s Address
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If a disciplinary or behavioral problem arises, what will you do?
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Is there anything else you would like us to know?
How did you hear about us?
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