Pet Adoption Application

Personal Information




Briefly tell us about the other adults in your household



Briefly tell us about any children in your household




Residential Information
If your application is approved will you consent to a home check.   Yes   No
Do you live in a
 house    apartment    other  
Do you  own    rent    live with family    live with friends
Does your residence have:
a fenced yard   a doggie door   a patio   a porch
If you're renting your residence please answer the following:
Landlord's name Phone number
Does your landlord:
Allow pets   Yes     No     Don't know  
Have size restrictions   Yes     No     Don't know  
Charge a deposit   Yes     No     Don't know  
Charge extra rent   Yes     No     Don't know  
Your new pet
Which animal are you interested in adopting ?
Why are you planning to adopt a dog? (check all that apply)
   For a companion    For hunting    Bark at strangers
   For yourself    For your family    Buddy for another pet
   As a gift    As a guard dog    Running partner
What qualities are you looking for in a new dog?
Please list any concerns you have about your new pet,
or any questions you may have for us.
Do you have experience training dogs for any of the following:
Obedience Housebreaking Agility Other
 yes  no  yes  no  yes  no
How will you deal with destructive behavior like chewing, digging, or jumping?
What will you do if your new dog bites or snaps at a family member?
Who will have the primary responsibility for the following:
Feeding   Obedience
Vet Care Exercise   
Routine health care can cost up to $300.00 a year and emergencies are often over $1,000. Are you willing to provide this care if necessary ?  Yes   No
Where will your new pet be kept:
At night If you move
During the day When on vacation
On an average day how long will the pet be left alone?   
How many days a week?   
What will you do with your new dog if you can no longer keep it?
Will your new pet be allowed
On the bed    Yes   No In the car    Yes   No
In the pool    Yes   No In the yard    Yes   No
In the house    Yes   No On the couch    Yes   No
Current or Previous Pets
How many pets do you have now?
Dogs Cats Others
Are your current pets vaccines up-to-date?     Yes  No  Don't Know
Are they all spayed and neutered?  Yes  No  Don't know
Current veterinarian's name: Phone #
May we contact them to ask about your current pets?  Yes   No
Have you ever had to relinquish an animal to a shelter?  Yes   No
If so, what were the circumstances?
How many pets have you had in the last 10 years?
Dogs  Cats  Others 
Where are they now?
Please tell us a little bit about your previous pets and anything
else you would like us to know about your current pets.