adoption application

Adopter's Name *

First Name

Last Name

Adopter's DOB *

MM

DD

YYYY

Adopter's Phone

(###)

###

####

Co-Adopter's Name

First Name

Last Name

Co-Adopter's DOB

MM

DD

YYYY

Co-Adopters Phone

(###)

###

####

Adopter's address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Reference #1

First Name

Last Name

Personal Reference #1 Phone

(###)

###

####

Personal Reference #2

First Name

Last Name

Personal Reference #2 Phone

(###)

###

####

Personal Reference #3

First Name

Last Name

Personal Reference #3 Phone

(###)

###

####

If the dog is unavailable, would you be interested in similar dogs?

Yes

No

Maybe

What age of dog are you interested in?

Puppy 2 - 6 months

Young 6 mo - 1 year

Young Adult 1 - 3 years

Older Adult 3 - 7 years

Senior 7+ years

I have no preference on age.

Is there a specific gender you are looking for?

I have no preference.

Male Dog

Female Dog

Housing

Rent

Own

Other

If you rent, does your landlord allow pets?

Please be prepared to provide proof of landlord approval.

Yes

No

Does your landlord know you are looking for a new pet?

Yes

No

I haven't told them yet.

Do you have a yard?

You do not need an outdoor space to adopt a dog

Yes, a fenced yard.

Yes, an unfenced yard.

I don't have a yard.

Are all the members of your household in agreement about adopting a dog?

Yes

No

I haven't told them yet.

Does anyone in the household have pet allergies?

Yes

No

Are you willing to work through unexpected hardships with your pet and hire a trainer if need be?

This could include: house training, separation anxiety, socialization, fear, adjustments to other pets (and other pets’ adjustment to the new pet).

Yes

No

Not Sure

Do you agree to a representative conducting a home visit? *

Yes

Have you read and agree to our adoption agreement? (Link below) *

Yes

Do you agree to pay the adoption fee of $200 if approved? *

Yes