Staff Member You Worked With:
For  Canine #:     Canine's  Name:
Your   Name:    E-mail:
Home  Phone:   Work Phone:
Street address: City:   Zip:
How  long have you resided at this address?  
Do you rent or own your home?  
If you rent, you will need landlord approval:
Landlords Name:  Phone #:
Do you  live in an apartment?  
Do you have a completely secure fenced yard?   How high is it?
Will this pet be chained up or kept in a dog run?
If  in  a  dog   run,   what  are  the   dimensions? 
Do you have a pool? Is it Fenced?
What  type of  fence and how high is it? 
Have you owned a pet before?  Where did you get it? 
What other pets do you have in your home now? 
What  other pets have you owned in the last five years? 
What are  the  names of the pets? 
What  are  their  ages?  
Was a pet given away?   Why?  
How many children are in the home? Their ages?  
Will this pet be kept indoors, outdoors or a combination of both? 
Where will  this pet sleep?   (Indoors or Outdoors)? 
Who  is  your veterinarian?  
Veterinarians  Phone:  
On a regular basis,  how long  will the pet be left alone? 
Can you afford food?  Afford Veterinary Care?   Afford Grooming?   
Is anyone living in your home allergic to pets? 
Have  the  pets  you   have  in   your   home   now  or    the   pets  you  have  had   in  the   past  all   been spayed/neutered?    
If  you answerd  no,  why?  
Dogs requre time for training.  Do you have the time and are you willing to train and deal with behavior problems, i.e. digging, chewing,   jumping, etc?  

Any misleading or untrue statements on this application will result in immediate denial of any adoption from this facility.

By my signature or submission of this form, I verify that the above information is accurate and true and am giving my permission to obtain medical records from my veterinarian.


 
Copyright 2006  Pets & Pals
Last revised: October 2006