Adoption Application Form
APPLICATION FOR (NAME AND TYPE OF DOG):
DATE:
NAME OF APPLICANT:
STREET ADDRESS:
CITY, STATE ZIP:
HOME TELEPHONE NUMBER:
CELL PHONE NUMBER:
EMAIL ADDRESS:
OCCUPATION:
RENT OR OWN:
NUMBER OF ADULTS LIVING IN THE HOME:
WHO WILL BE THE PRIMARY CAREGIVER?
NUMBER OF CHILDREN LIVING IN THE HOME:
CHILDRENS AGES:
HOW MANY HOURS WILL THE DOG BE LEFT ALONE ON A TYPICAL WEEKDAY?
HOW MANY HOURS WILL THE DOG BE LEFT ALONE ON A TYPICAL WEEKEND DAY?
WHERE WILL THE DOG BE KEPT WHEN YOU ARE AT HOME (BE SPECIFIC)?
WHERE WILL THE DOG BE KEPT WHEN YOU ARE OUT (BE SPECIFIC)?
WHERE WILL THE DOG SLEEP AT NIGHT (BE SPECIFIC)?
DO YOU LIVE IN A HOUSE OR APARTMENT?
IS THERE A YARD? Yes No
IS THE YARD COMPLETELY FENCED IN? Yes No
WHAT IS THE HIGHEST AND LOWEST POINT OF THE FENCE?
HAVE YOU SCANNED THE ENTIRE PERIMITER FOR HOLES, CRACKS, OR POTENTIAL AREAS WHERE A DOG COULD SLIP THROUGH OR DIG OUT (I.E. SOFT DIRT TO DIG UNDER, BARS SPACED TOO FAR APART)? Yes No
IS THE GATE KEPT LOCKED? Yes No
WILL YOU INFORM YOUR GARDENER OR HOUSEKEEPER AND ANYONE WHO HAS ACCESS TO YOUR YARD TO BE USE CAUTION NOT TO LET THE DOG OUT? Yes No
DO YOU HAVE A DOGGY DOOR? Yes No
ARE YOU WILLING TO INSTALL ONE? Yes No
DO YOU OR ANYONE IN YOUR HOUSEHOLD HAVE ANY ALLERGIES TO PETS? Yes No
LIST ANY PETS YOU CURRENTLY HAVE AND THEY’RE AGES:
NAME, BREED, AGE
NAME, BREED, AGE
NAME, BREED, AGE
HAVE YOU EVER OWNED A DOG BEFORE? Yes No
NAME, BREED
NAME, BREED
NAME, BREED
WHAT ARE YOU LOOKING FOR IN A DOG?
WOULD YOU EVER EUTHANIZE A DOG? Yes No
IF SO, UNDER WHAT CIRCUMSTANCE?
HOW WILL THE DOG BE EXERCISED?
HOW OFTEN WILL THE DOG BE EXERCISED?
WHAT WILL THE DOG’S DIET CONSIST OF?
MAY WE CONDUCT A HOUSE-CHECK PRIOR TO ADOPTING? Yes No
WHAT WILL YOU DO WITH THE DOG IF YOU MOVE SOMEWHERE WHERE DOGS ARE NOT WELCOME?
ARE YOU ABSOLUTELY SURE THAT YOU ARE READY TO MAKE THIS LONG-TERM COMMITMENT? Yes No