Application to Adopt

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Application to Adopt

* Fields are required

Subject *
E-mail *
First Name
Last_Name
Date of Birth	MM/DD/YYYY
Address
Address
City
State/Province
Phone	###-###-####
Name of Dog of your interest
Residence	Own Rent House Apartment Condo
If you are renting does the landlord allow pets?	Yes No
Please provide the name and contact number for the management for verification
Number of adults (18+) in the household
Number of children (under the age of 18) in the household
Ages of children
Are any of the household members allergic to dogs?	Yes No
Does anyone in your household smoke?	Yes No
In the event of an emergency, what is the estimated vet bill you can afford?
Type of fence
Height of fence
The dogs will stay	Indoors Outdoors Both
Have you owned a pet in the past? If "Yes," please describe.
Do you currently have any pets? If "Yes," please describe. (Include animal type, breed, age, personality, etc.)
If your pet is a "Dog", is it spayed/neutered?	Yes No
If you answered "No" above, please explain why.
Do you have a primary vet?	Yes No
If answered "Yes" above, please provide name and address.
May we contact them?	Yes No
Where will the dog sleep?
How long will the dog be left alone in a regular day?
What kind of experience do you have with dogs and breeds?
What other factors you feel should be considered?
How did you hear about us?	Adopt a Pet Petfinder Facebook Instagram Twitter YouTube Friend/Family Other
Would you like to receive newsletters and future updates from the rescue?	Yes No
Signature	First Names / Last Name
Today's Date	MM/DD/YYYY
Question and Comment *