NAME______________________ ________________                                                puppy______ dog______

____________________________________________                                            

____________________________________________                                               Dog Name:_______________

PHONE ____________(home) ________________(work) 

EMAIL ADDRESS ____________________________________

Why do you want to adopt a pet? ______________________________________________________________________________________

Who will be the primary caretaker of this pet:_____________________________________________________ 

Is there anyone in the home who may be adversely affected by care of dogs/cats
(allergies, etc.)?____________________________________

Do you live in a.. House_______Townhouse_____Apartment_____Condominium_____Mobile Home_____ 
Do you: Own_____ Rent_____

Do you have the landlord’s permission to have a dog/cat? _____  
Landlord Name/Phone #_______________________________________

Do you have a fenced yard? _______ Yard Size ___________Type and height of fence?___________________ 

Where will the animal be kept during the day? ____________________ At night? __________________________

Will this be your first pet?_____________ List any other pets you have, if they are on heartworm preventative and if they are spayed or neutered:

_________________________________________________________________________________________________________________


_________________________________________________________________________________________________________________

Do your pets get along with other animals?__________________________________________________________________________________________________________

Have you had other pets in the last 5 years and what became of

them?_____________________________________________________________________________________________________________

Are your pets up to date on vaccinations?_________ May we contact your veterinarian? ________ Please provide name,

address and phone # of most recent veterinarian: _______________________________________

Are you prepared for the expenses of yearly boosters, emergency medical care and routine care for possibly

10-15years?_________________

Adults in the home_______ Children in the Home _______ Children’s ages __________________ Do all members of

household want to adopt this pet? ___________

How long have you lived at your present location? __________________________________ 

Do you anticipate moving in the near future? _______________________________________

Are you willing to make a lifetime commitment to this pet? _____________________________

_________________________________________________________________________________________________________________
DISPOSITION

Approve:____________    Denied:______________   Reason for Denial: _________________________________