Adoption Form

Name of dog you are interested in, if applicable:

Tell us about Yourself:

Name* (primary owner of the dog):
Age*
Email*
Home Address
City*
State*
Zip*
Home Phone*
Mobile Phone*
How long have you been in your current home?
Current Employer
How long have you been at your current job?

Tell us about the Co-Owner of the dog

Co-Owner's Name*
Co-Owner's Age*
Co-Owner Email*
Co-Owner's Home Phone*
Co-Owner's Mobile Phone
How long has Co-Owner been in your current home?

Tell us about the Household

Total Number of People in household
Number of Adults
Number of Children
Age(s) of Adults/Children
Does anyone in the house smoke?YesNo
Is everyone in the household in agreement about adopting a new pet?YesNo
Does anyone in the household have any known animal allergies?YesNo
If yes, please specify*

Tell us about your Home

Do you Own or Rent your home?
What type of Dwelling is your home?
Is your yard fenced in?YesNo
If your yard is fenced in, what is the height of the fence?
Are there any breed/size restrictions where you live (by apartment management, condo or homeowner's association)?YesNo
If so, what is restricted?

If you rent, please provide your Landlord's information

Landlord's Name
Landlord's Phone
Landlord's Email

If you rent, have you already paid a pet deposit (if required)?YesNo
Did your family have pets when you were growing up?YesNo

Current Pets

Your Current Pets

Your Previous Pets
Have you ever turned an animal into a shelter? If yes, please explain
Your Veterinarian's Name
Your Veterinarian's Address
Your Veterinarian's Phone
Your Veterinarian's Fax
What do you know about Heartworms?

Tell us about adopting your new dog

Where will your new pet be kept during the day?
Where will your new pet be kept at night?
How many hours during the average day will your pet be alone without a human?
If your new pet is a dog, how do you plan to provide exercise for it (check all that apply)?Leash Walk EverydayWill Have Cable or Dog Run in YardWill Be Free To Run in Fenced YardWill Have Supervised Access to unfenced yardWill be Free to Roam AroundWill Take Dog to Dog Park
How long have you been considering adopting an animal?
If you/someone in your home were unable to care for your adopted pet, who would be responsible for the animal’s needs?
What age, breed and other desired characteristics that you are looking for in your new dog?
Please tell us why you are interested in adopting? Check all that applyCompanion for SelfCompanion for FamilyFor BreedingGiftFor ProtectionFor ChildReplace Previous PetCompanion for Other PetOther, please specify
"Other" reason for adopting
Are you prepared to spend weeks or, perhaps months waiting for your new pet to adjust to its new environment?
Do you anticipate any major changes in your life that could affect a pet, such as a move, new baby, change of job/schedule, in the next year? 2 years? 5 years? Please Explain:

Please enter your full name (this will act as your signature):
Please enter today's date