Dog Adoption Form

CONTACT INFO


* Your Name

* Your Email

* Street Address

* City

* State

* Zip Code

* Phone Number

* Phone Type

* Alternative Phone Number

* Phone Type

HOUSEHOLD INFO


* Are you over 18

* Do you own or rent a home
Rent    Own

* How many children live in the home and what are their ages

* How many hours each day will the adopted animal be without human companionship?

ADOPTION INFO


* Are you interested in any particular dog(s)? If so, which one(s)?

Otherwise, describe in detail the type of dog you're looking for:

* Will this be your first dog?

* Why do you want this dog?

If other, please explain why you want this dog

* Where will the dog sleep? Please be as specific as possible.
(basement? garage? kennel? bed in the house, etc).

* Does everyone living in your home know about and agree with your decision to adopt a dog?

If not, why?

* Are there times when the dog will be tied up?

If yes, when will it be tied up?

* Will you keep the dog up-to-date on vaccinations, provide proper medical care & exercise as needed?

* Are you willing to have a representative of Pets Alive come see where the dog will be living?

* If you move, will you take the dog with you?

If no, please explain why not

* Are you willing to take responsibility of this dog for the next 10 to 15 years?

If no, please explain in detail

* How much are you willing to spend on medical bills for your dog?

What would you do if vet bills went over this amount?

* Please provide one reference that is NOT your vet or someone living in your home (name AND phone number please):

* Please provide your veterinarian's information - name and phone number (after submitting this form please CALL your vet & give them your permission to speak to us) :

PREVIOUS PET INFO


* What animals do you CURRENTLY have? Include age, sex, breed and species.

* What happened to the pets you no longer have?

* Are all your current pets spayed or neutered?

* Have you ever had a pet euthanized?

If yes, please explain further

* Have you ever turned in a pet to a shelter?

If yes, please explain the circumstances:

* Have you ever applied to Pets Alive before to adopt an animal?

If yes, when?