Dog Adoption Application

Submitted by Anonymous (not verified) on Mon, 05/12/2014 - 12:07

Please select type of application: *

Foster

Adopt

Foster-to-Adopt

Pet Name *

Located pet at/on

Name of Applicant *

Name of Co-Applicant

Applicant Address *

City *

State *

Zip *

Primary Phone *

Secondary Phone

Email address *

Best time of day to contact *

Applicant Occupation & Work Schedule *

Are you aware that routine costs to maintain a pet average $500 to $800 dollars a year? *

Please list all members of the household (excluding pets), first name and age

Please list all pets in household

Are all household pets spayed/neutered? *

If "no," please indicate status of pet

Are all dogs in your household on year-around heartworm preventative? *

What is the name of the Heartworm preventative used? *

Other than children living in the household, will your pet come in contact with other children under the age of 5? *

Do any elderly or physically challenged people live with you or visit frequently? *

Do you own or rent your home? *

If you rent, do you have your landlord's permission to have a pet?

May we contact your landlord to verify permission?

Name of your landlord

Landlord's Phone Number

Do you have a fenced yard? *

Describe fence height and condition:

Do you have a dog door? *

What breeds of dogs have you been companion to? *

Will this be your first pet? *

Have you ever bred a pet? *

Have you ever sold a pet? *

Have you ever given a pet away? *

Have you ever surrendered a pet to a shelter? *

If you answered yes to any of the preceding questions, please explain the circumstances:

Do all family members want a pet? *

Please tell us the reason you want a pet *

Why do you think you would be a good caregiver to a pet? *

What age pet fits your lifestyle and expectations? *

Are you aware that some pets are very active? *

Do you have time and are physically able to give active pets adequate exercise? *

Is anyone home during the day? *

How long will the pet normally be left alone during the day? *

Are you aware that all pets shed year around? *

Is anyone in your home prone to allergies or may be adversely affected by a pet? *

Describe activities that your pet would be included

(i.e. swimming, camping, family outings)

Where will the pet be kept during the day when no one is home? *

When you travel with your pet, will they: *

If you said "in a truck bed," how will you restrain your pet to prevent accidents? *

Pet will be primarily kept

Indoors

Outdoors

If you become sick or hospitalized, what provisions can you make for your pet?

What brand of pet food do you currently use?

What will happen to the pet if you get married, divorced or have children?

If you move, what will you do with your pet?

Are you familiar with the use of a dog crate to confine the pet during any absence, for their safety, as an aid in housebreaking or to provide them a safe haven?

Where will your pet sleep at night?

Please check all that apply to pet:

Have the run of the house

Be blocked off parts of the house

Be crated

Be tied outside

Live in a fenced backyard

Live in a dog run

Roam loose in the neighborhood

Are you familiar with your local, county and state laws? *

May we visit your home prior to application approval? *

Indicate best time/day for home visit:

May we contact your veterinarian? *

Veterinarian Contact Information *

(Clinic Name, Address, Phone Number)

How would you discipline your pet? *

Have you ever had a pet with behavior issues?

How many years will you keep your pet?

Who is primarily responsible for pet? *

How would you try to find a lost pet? *

How would you deal with destructive behavior by your pet? *

How would you know if your pet became ill? What type of symptoms would you expect? *

Our volunteers may take up to two weeks to complete the adoption process; are you willing to wait? *

Loving Arms Pet Placement will require a $250 donation if application is approved; are you willing to pay this amount? *

Answers are expected to be complete and truthful, as they will enable us to better comply with your requests and requirements. Failure to provide accurate information can result in revocation of the adoption at any time by Loving Arms Pet Placement. By completing this form the undersigned expressly give permission to Loving Arms Pet Placement to verify information contained in this application, and further release Loving Arms Pet Placement from any and all liability associated with this application or the adoption process.

Agree or Disagree? *

I/We attest that the Terms and Conditions of Adoption, as stated above, have been read in full by Me/Us and I/We understand that these terms constitute a part of the adoption agreement between Me/Us and Loving Arms Pet Placement and will be enforced.

Agree or Disagree? *

I/We attest that information provided on this application is true and accurate to the best of My/Our knowledge. I/We understand that completion and submission of this application does not guarantee adoption of a pet. If application is submitted electronically, I/We further attest that no changes have been made to the content of this document and understand that my approval by signature is assumed and agree to transmit a signed original or facsimile prior to any decision by Loving Arms Pet Placement on my Adoption application.

Agree or Disagree? *

Comments or Suggestions

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