Adoption Application 
City, St. Zip
Home phone

How many ADULTS in the home ?
 Cell phone
How many CHILDREN in the home ?  Please list ages as well. 
How many PETS in your home ?  Please list their sex,age, if spayed  or neutered, and how you acquired them.
Please list your experience you have with pets (even if you have none currently)
Please list the name and phone# of your veterinarian.
Veterinarian's Name
Veterinarian's Phone
Veterinarian's Address
Please list the name of the DOG you would like to adopt.
How do you plan to exercise your new pet ?  (walk on leash, play in yard, kennel run, or ....
How many hours a day will your pet spend alone ?
Where do you intend to keep your pet during the day?
Where will your pet stay when you are not home?
Have you ever used a crate for a puppy or dog ?
Have you ever completed a dog training class ?
What circumstance would cause you to "give up or return" your new pet ?
HOME VISIT is required before adoptions are approved, are you willing to have a home visit ?
Do you OWN or RENT  your home ?  How long have you lived at this residence ?
If you RENT, please provide your landlord's name and phone #
Landlord's Name
Landlord's  Phone
Do you have a FENCED YARD ?  If so, please note the type of fence  (chain link, privacy, farm fence, or.... 
Please provide 2 references (not related) who have personal knowledge of your experience with animals. 
How does this person know you ?
How does this person know you ?
Your signature
I certify the information I have provided is true, and I realize that any misrepresentation of facts may result in my losing the privilege of adopting a pet.    I understand you have the right to deny my request to adopt an animal for any situation OR if not in the best interest of the animal.  I authorize investigation  of all statements in this application, and also authorize my vet to release any information requested by you. 
Adoption Application 
Email address