Dog Adoption Form Step 1 of 4 - Applicant Info 25% Date Date Format: MM slash DD slash YYYY Applicant Name First Last AgeSpouse/Roommate Name First Last AgeAddress Street Address City State / Province / Region ZIP / Postal Code (PO box unacceptable) Home PhoneCellWorkSouse/Roommate HomeCellWorkEmail (both applicants) Living SituationHouseApartmentCondoMobile HomeDo you own or rent your home?OwnRentHow long have you lived at this address?If you rent, please provide name and phone number of landlord or HOA contact person:What is your current occupation?Who is your current employer?Does your job require extensive travel?YesNo How many adults are in your family?Full name(s) if other than adopter(s)How many children?Gender & age?Why, specifically, do you want a dog?Will this be your first dog?YesNoDo you currently have pets? If so, list breed, age, sex & temperament (alpha or submissive)Are these pets on heartworm prevention?YesNoBrandHave they been spayed or neutered?YesNoDon't KnowAre they current on vaccinations?YesNoDon't KnowWas your last dog obedience-trained?YesNoDoesn't ApplyWhy do you want this dog? (Check all that apply.) Companion Companion for other pet House pet Watch dog Guard dog Hunting Personal protection Other (explain)Who is your veterinarian?Name of PracticePhoneCity/StateHave you ever surrendered any of your animals to a shelter?YesNoIf yes, please explain:Have you ever had a pet euthanized?YesNoIf yes, please explain:Is your yard fenced?YesNoWhat kind of fence?Fence height at lowest point?How big is your yard?Is there a gate?YesNoWill gate be locked to protect your dog?YesNoDo you have a dog door?YesNoIf you live in Palm Beach County, will you abide by the Palm Beach County anti-tethering ordinance by not chaining the dog?YesNoDoes any member of your household have an allergy to dogs?YesNoIs someone home during the day?YesNoIf yes, who?How many hours each day will the dog be without human companionship?Where will the dog be kept during the day?At night?Where will the dog stay when the family is out of town?Do you crate your pets?YesNoAre you able and willing to exercise the dog on a regular basis?YesNoIf yes, method of exercise:If your new dog/puppy is not housebroken, what method will you use to train him/her?Would you be willing to take the dog to obedience classes?YesNoIf no, why?If you drive a pickup truck, would you allow the dog to ride in the back?YesNoIf yes, please explain:If you move, will you take the dog with you?YesNoIf no, please explain:Are you willing to take responsibility for this dog for the next 10 to 15 years?YesNoIf no, please explain:What provisions will you make for the dog should you become unable to care for him/her?UntitledHow much are you willing to spend on medical bills for your dog?Up to $100Up to $500Up to $1,000Up to $5,000Whatever it takesHave you ever applied to Save A Pet before to adopt an animal?YesNoIf yes, when?How did you find out about Save A Pet?Name of dog you would like to adopt Personal Reference 1 First Last RelationshipAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Personal Reference 2 First Last RelationshipAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail
