Adoption Application

Personal Information:

Name: *
Address: *
E-mail: *
Cell Phone: *
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Home Phone: *
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Age: *
Number of adults in the household: *
Relationship:
Number of children in the household: *
Age of children:
Does anyone living in the household have allergies to dogs? *
Do you own your own home? *
In you rent, please provide landlords name and phone number (we require landlord concent to adoption):
Do you have a fenced yard? *
Type of fence and fence height:

Current Pet Information:

Pet 1 - Name:
Pet 1 - Type of Animal:
Pet 1 - Breed:
Pet 1 - Where are they now:
Pet 2 - Name:
Pet 2 - Type of Animal:
Pet 2 - Breed:
Pet 2 - Where are they now:
Pet 3 - Name:
Pet 3 - Type of Animal:
Pet 3 - Breed:
Pet 3 - Where are they now:

Adoptable Dog

Name of the dog you are interested in: *
Are you interested in a specific breed? If yes, which breed and why? *
Age of dog you are interested in: *
Gender of dog: *
Desired energy level of adoptable dog: *
What traits are you seeking in a dog? *
What traits are you looking to avoid? *
Where will the dog live? *
When the dog is home alone, where will he/she be? *
How many hours will the dog be left alone during the day? *

References:

Current Veterinarian Name: *
Current Veterinarian Phone: *
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Can you afford veterinary care for your pet, which can average over $100 per visit? *
Personal Reference 1 - Name: *
Personal Reference 1 - Phone: *
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Personal Reference 1- Relationship: *
Personal Reference 2 - Name: *
Personal Reference 2 - Phone: *
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Personal Reference 2- Relationship: *