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* If you are interested in adopting a particular dog, please list his/her name below: |
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Personal Information |
* Name |
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| * Name of spouse or signifiant other: |
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| * Address |
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| City |
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| State |
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| Zip |
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| Phone - Work |
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| * Phone - Home |
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| * Driver's License # |
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| * Email |
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What is your Pet Experience |
| Is this your first dog? |
Yes
No |
If yes, how have you prepared your home and family (chewing, exercise,
housebreaking, training)? |
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Why do you want to adopt a dog? (Check all that apply) |
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Companionship |
Breeding |
| For
Children |
For A
Gift |
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Hunting |
Guard
dog |
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Other, Please explain
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Do all your family members support this adoption? |
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Yes
No |
How much do you know about the breed/mix that you are adopting? |
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Home, Family & Living Circumstances |
Number of Adults and Children living in your household and ages. |
| Adults & Ages -
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| Children & Ages -
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Does anyone in your household have allergies? If yes, please
explain. |
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Do you have a fenced yard?
Yes
No |
If yes, what type of fence, i.e how tall, wood or chain? If no,
how will your dog be restrained when outdoors? |
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Do you...? (check all that apply) |
| Own
Home/Condo |
Rent Home/Condo |
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Rent Apartment |
Live in Mobile Home Park |
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Live with someone else |
If Renting, Landlord's FULL name and phone number... |
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Do you live where there are restrictions against owning dogs?
Yes
No |
| Where employed: |
| Name of employer, address & phone number | |
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Pet Information - Current & Past |
How many animals do you have now?
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How many dogs? |
| Dogs' names (if applicable)
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| Dogs' breeds (if applicable)
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| Sex of dogs?
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| Age of dogs?
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| How many cats?
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| Cats' names (if applicable)
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| Sex of cats?
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Are your pets all spayed or neutered?
Yes
No |
If your pets are not spayed/neutered, please explain why they are not. |
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Have any of your pets run away? |
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Have any of your pets been hit by a car or killed on the road? |
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Have you ever had to put an animal to sleep? If yes, please
explain. |
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Have you ever given a pet away? If yes, please explain. |
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Where will the dog spend most of it's time? |
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In the house |
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Outside |
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Other, Please explain
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Do you believe that a pet is a lifelong commitment? |
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What would you do if you could no longer care for this dog? |
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Under what conditions could you no longer keep this dog?
Please Explain: |
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If your new dog has housebreaking problems, what will you do to make it
work? |
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Crate |
Leave Outside |
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Bring Back Too Us |
Other |
| Explain Other - |
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If you have to go away for several days or longer, who will care for your dog? |
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Vet Information |
Do you take your pets to a Veterinarian for annual checkups?
Yes
No |
| * Who is your Vet? |
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| Vet's Address |
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* Vet's Phone Number
(we must have a phone number to verify) |
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| * I give the Vet permission to release information to Orphaned Kanines on my account |
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Yes
No |
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Signature & Date |
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* Would you allow a Rescue Representative to visit your home regarding this adoption? |
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Yes
No |
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By signing below, I certify that the above information is true. I understand the misrepresentation of any information may result in the loss of my adoption privileges. I authorize the investigation of all statements made in this application and realize that an agent of Orphaned Kanines may contact other humane agengies, shelters, veterinarians, landlords and /or family members. I further understand the adoption of the dog may be delayed until all information can be verified and missing information obtained. This application becomes the property of Orphaned Kanines Inc. and will not be returned. Orphaned Kanines Inc reserves the right to deny the adoption of any dog to anyone based on the information or lack of information provided in this application. The decision of Orphaned Kanines Inc is considered final.
* Signature
* Date |
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