Animal Adoption Application
Today's Date
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Month
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Day
Year
Date
Name or breed of dog you are interested in
*
Your name
*
First & Last Name
Your Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Your Email
*
Your Phone Number
*
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Area Code
Phone Number
Phone Type
*
Cell
Home
Work
Driver's license number
Do you live in a:
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Single Family Home
Duplex/Twin
Condo/Townhome
Trailer
Apartment
Other
Do you rent or own this property?
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Rent
Own
Do you have a yard?
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Yard, fenced with a vertical fence
Yard, fenced with invisible fencing
Yard, no fence
No yard (apartment/condo/townhome)
Other
If you have a fenced yard, what height is the fence?
Household makeup.
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Adults
Children
Ages of children if applicable
Are children planned for the future or do children visit the house?
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Children planned for the future.
Children visit the house
Who is the major person responsible for the pet?
*
Is anyone in your home allergic to the animal you're planning to adopt?
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Yes
No
Yes, but it is tolerable for them and they are OK with it.
Hours a day the pet will be left alone?
*
Do any neighbors pets come into your yard?
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How close is your nearest neighbor?
Can we contact them?
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Yes
No
If yes, please provide phone Number.
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Area Code
Phone Number
Or other personal reference.
*
Reference's Phone Number
*
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Area Code
Phone Number
How do you know this person? (example: friend? coworker? related to you and how related)
Do you have a cat/kitten? Is it an indoor cat or outdoor cat?
*
Please list any pets currently living in your home, and if they are vaccinated and spayed/neutered.
List pets you've had in the past and what happened to them?
Vets name?
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Vets Phone Number
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Area Code
Phone Number
Pet's name and last name the records are under, if different from above.
Additional reference (if desired)
Tell us why you think you'll be the best home for the dog
*
By checking the box below, you certify the information given is accurate.
I understand the above, and have tried to the best of my knowledge to make sure all information is correct.
Adopter's Signature
*
Signature date
*
Submit (thanks!)
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