subject_line
Forgotten Dogs of the 5th Ward Project
Adoption Application
Name
(First and Last)
*
Email address
*
Phone
(Primary number)
*
Work/Alt Phone
Home Address
(No PO Box)
*
City
*
State/Province
*
Zip/Postal Code
*
Personal References
(Please list three references and include at least one relative not living with you. Provide their Name, Phone Number, and Relationship to you.)
*
Name of dog/cat you wish to adopt
*
How did you hear about this rescue?
Do you live in
(Please select one)
*
House
Apartment
Condo/Townhome
Trailer
Other
Other
Do you own or rent/lease?
*
Own
Rent/Lease
If you rent/lease, please provide name and number for your landlord or management co.
Are you planning to move in the next six months?
*
Yes
No
What will happen to the dog/cat if you have to move unexpectedly; in case of emergency; and when you go on vacation?
*
Have you ever had pets in the past?
*
Yes
No
Name/Phone number of your veterinarian
Do you have any pets currently?
*
Yes
No
If Yes, please include information about your current pets. (Name, species, breed/mix, age, spayed/neutered, etc.)
Do you want this dog/cat to be
*
Inside
Outside
Both
On average, how many hours will the dog/cat be left alone?
*
Where will the dog/cat be kept during the day?
*
... at night?
*
... when you are not home?
*
Do you have a yard?
*
Yes
No
If Yes, is the yard fenced?
Yes
No
Other
Other
If Yes, please describe the fence
Material (chain link, wood, wrought iron, etc.) and height
If Yes, have you checked your fence for escape routes?
Yes
No
If Yes, does your fence have a lock?
Yes
No
If not, could a lock be put on?
Gates should always be locked so that the dog can not accidentally be let loose by neighborhood kids, utility service personnel, etc.
Yes
No
Other
Other
Do you have a doggie door?
*
Yes
No
If there is no fenced yard, who will exercise the dog, how, and how often?
If you own a truck, how do you plan to transport the dog?
What do you know about heartworms?
*
If you currently have a dog, what kind of heartworm prevention is he/she on?
Are you prepared to potty train/house break your new pet?
We are happy to provide support to make this successful!
*
Yes
No
Other
Other
What kind of behavior do you find unacceptable in a pet?
*
Are you willing to take your dog to training if necessary?
*
Yes
No
Other
Other
Please tell us why you would like to adopt a new dog/cat.
*
I am applying to adopt this dog/cat for
Check all that apply.
*
Myself
Significant other
Children
Family
Gift
Other
Other
Please list everyone your new dog/cat will be living with (including yourself).
Name, age, and relationship to you.
*
Additional comments?
Powered by
Report abuse