Dog / Puppy Adoption Application All applications are subject to review by the Adoption Committee. Completion of this application does NOT guarantee an adoption. All items marked with an asterisk must be provided. Please enter NA to items that may not pertain to your situation. Step 1 of 5 20% Pet's Name*Your Name* First Last Applicant's Date of Birth* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone*Second PhoneThird PhoneEmail* Are you adopting for:*YourselfYou and your familyChild/renBusinessOtherOtherHow many people live in your home?*Number of children?*Children's Ages?*Why do you want to adopt*What is your living situation?* House Apartment Condo Mobile Home Other Otherb.* Own Rent Living with family member/roomate/spouse Landlord contact informationIs your yard fully fenced?* Yes No Fence MaterialFence Height On average, how many hours a day will the dog be alone?*Dog’s primary living quarters will be:*InsideOutsideIndoors & OutdoorsWhere will the dog stay while you are away from home?* Indoors Outdoors If Indoors, then Loose in Home Crated Confined to a Room If Outdoors, then Loose Outside Confined to Garage/Barn Other Please describe what you are looking for in your new dog?*Please describe how you plan to train & discipline your new dog?*If you currently have pets, or had pets in the past, which veterinary clinic(s) do you use?*Enter "N/A" if this question does not apply to you currently.According to the ASPCA the average annual cost of owning a dog is $650. Are you prepared to make this commitment?* Yes No Unsure Please complete the following for all pets you currently have:First animal's name / sex?First animal's type/ breed?First animal spayed / neutered?YesNoHow long have they been with you?First animal's current age?First animal's health / behavior problems?Second animal's name / sex?Second animal's type/breed?Second animal spayed / neutered?YesNoHow long have they been with you?Second animal's current age?Second animal's health / behavior problems?Third animal's name / sex?Third animal's type/breed?Third animal spayed / neutered?YesNoHow long have they been with you?Third animal's health / behavior problems?Fourth animal's name / sex?Fourth animal's type/breed?Fourth animal spayed / neutered?YesNoHow long have they been with you?Fourth animal's current age?Fourth animal's health / behavior problems?Fifth animal's name / sex?Fifth animal's type/breed?Fifth Animal spayed / neutered?YesNoHow long have they been with you?Fifth animal's current age?Fifth animal's health / behavior problems?Please discribe your PREVIOUS pets (include pet names, breeds, spayed/neutered, dates owned) Please list 2 personal references. Name, relationship, and phone#*Although I understand that every animal adopted has been inspected and its history reviewed, I appreciate that you can make no warranty in regard to the pet and that you can give only such information as you have received with regard to the pet. I shall be personally responsible for the humane care and control of the pet. I further understand that any donation I have given to the Animal CCare Society is a donation towards its work in caring for the pets.*I agree to Certification terms and conditions listed above.I CANNOT abide by the Certification terms and conditions listed above.Although I understand that every animal adopted has been inspected and its history reviewed, I appreciate that you can make no warranty in regard to the pet and that you can give me only such information as you have received with regard to the pet. If, for any reason, I am not able to care for my adopted pet, I will contact the Animal Care Society for acceptance Into the Center and re-adoption. The Society will determine whether or not the pet can be accepted for re-adoption. If the Animal Care Society demands the pet's return for any reason, I agree to promptly return the pet to the Center. I shall be personally responsible for the humane care and control of the pet, and l agree that your agent shall be allowed to see the pet at any reasonable time. I further understand that any donation I have given to the Animal Care Society is a donation towards its work in caring for pets. I give the Animal Care Society my permission to obtain information from veterinarians who have seen/treated my pets.
