Adoption Application

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• Must be 21 years or older with identification showing present address.
• Must have the knowledge and consent of all adults living in the household.
• Renters must show proof of pet deposit and lease allowing pets if renting.
• Must be able and willing to spend the time and money necessary to provide training, medical treatment and responsible care for a pet.

Applicant Name: *

Full Address: *

Name of Dog you are interested in adopting *

Best contact Phone: *

Alt Phone:

Email: *

DOB: *

Number of children in household? *

5 or more

Ages:

Number of adults in household? *

5 or more

Number of dogs living in your home: *

5 or more

Number of cats living in your home: *

5 or more

M/F and number of each?

Approximate weight of each?

Breeds:

Are any of your pets unsterilized? *

If so, explain:

Are all dogs current on their shots? *

yes

Are all dogs on heartworm preventative? *

yes

Are all dogs on flea/tick prevention medication? *

yes

Have any of your current pets had medical problems in last 12 months?

Description of medical problem(s):

Any behavioral problems with your current pets?

How are the problems being addressed?

Would you seek help from a trainer if the pet you want to adopt develops a behavioral problem?

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