SUBJECT:
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Name
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First Name
Last Name
Email Address
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Home/Cell Number
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Work Number
Are you 21 years or older?
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Date of Birth
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Address
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City
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State
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Zip Code
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County
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Place of Employment
Household - Spouse/Partner/Significant Other: (First and Last Name)
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Please tell us why you want to adopt this pet:
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I am adopting this dog for:
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My housing is
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Type of Residence
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Landlord's Name & Number
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Number of Children in Household:
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Ages of Children in the Household:
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Number of Adults in Household:
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I have children who visit frequently. Their ages are:
I have owned a pet in the past five years
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Pet Name:
Breed:
Age:
Spayed/Neutered
Current on Vaccines
Tested for Heartworm annually and on Seasonal Prevention?
If "No" to any of the above, please explain why:
What happened to this animal?
Pet Name (Second)
Breed
Age
Spayed/Neutered
Current on Vaccines
Tested for Heartworm annually and on Seasonal Prevention?
If "No" to any of the above, please explain why:
What happened to this animal?
Pet Name (Third)
Breed
Age
Spayed/Neutered?
Current on Vaccines
Tested for Heartworm annually and on Seasonal Prevention?
If "No" to any of the above, please explain why:
What happened to this animal?
I have a veterinarian:
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Vet Name:
Vet Phone Number:
Vet records are under the (Human) First & Last Name of:
If no current vet, please list last vet used in the past five years:
Vet Phone:
I have:
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If a fenced in yard, what type:
When I am NOT home, or not able to supervise my dog, my pet will be:
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During a workday 24-hour period, my pet would be alone (Number of Hours):
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My adopted dog needs to get along with other dogs:
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Or cats/other animals
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A member of my household is allergic to dog hair/animal dander:
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If yes, who:
Ref. 1 Name:
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Ref. 1 Phone:
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Ref. 2 Name:
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Ref. 2 Phone
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Are there any question or issues you would like to discuss with our Adoption Counselor?
If I adopt a dog from Pound Buddies, please donate my $25 "Good Faith Spay/Neuter Refund" back to Pound Buddies so they can help other animals.
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I
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Type Full Name:
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Date & Time:
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