DOG ADOPTION APPLICATION Dog Name Your Name Home Phone # Cell Phone # Email Address Date of Birth Address City, State Zip Code Occupation and Work Schedule Spouse/Partner/Roommate Name Spouse/Partner/Roommate Occupation and Work Schedule Their Phone Number Their Email Names of all persons living in your household with Relationship & Age References Please submit at least 2 references that are not related to you. Name of First Reference Phone Number of First Reference Name of Second Reference Phone Number of Second Reference Name of Third Reference Phone Number of Third Reference About your Home Home Private Home Apartment Other Do you have a yard? Yes No Is it fenced? Yes No Height of fence - If applicable Is there a pool on your property? Yes No Is the pool fenced? Yes No Do you have any of the following? Balcony Pet Door Unscreened Windows/Doors Does your home have any other means of outdoor access for a dog? Yes No Your home has: 1 Story 2 Stories 3+ Stories Do you? Own Rent Other If not a homeowner do you have permission to have a dog? Yes No If renting, what are the rules about having pets? Landlord's name & phone number - if applicable: About Pets Current pets. Species & Breed. Owned how long. Age/Sex Altered? What is your family lifestyle? Are your pets kept indoors or outdoors? In Out Past Pets. Species/Breed owned how long and What happened? Has anyone in your household experienced allergies to pets? No Yes Veterinarian’s Name & Phone Number What are the reasons behind your decision to adopt now? Who will be responsible for the care of the pet? Why do you think you want this particular pet? If the pet becomes ill or injured, are you financially prepared to provide medical care? Yes No If yes, is there a maximum amount you would spend? Send
