SUBJECT:
*
Name
*
First Name
Last Name
Email Address
*
Home/Cell Number
*
Work Number
Are you 21 years or older?
*
Yes
No
Date of Birth
*
Address
*
City
*
State
*
Zip Code
*
County
*
Place of Employment
Household - Spouse/Partner/Significant Other: (First and Last Name)
*
Please tell us why you want to adopt this pet:
*
I am adopting this dog for:
*
Myself
My Children
My Family
A Friend
A Relative
My housing is
*
Rent
Own
Live with Roomates/Parents
Type of Residence
*
House
Apartment
Condo
Other
Landlord's Name & Number
*
Number of Children in Household:
*
Ages of Children in the Household:
*
Number of Adults in Household:
*
I have children who visit frequently. Their ages are:
I have owned a pet in the past five years
*
Yes
No
Pet Name:
Breed:
Age:
Spayed/Neutered
Yes
No
Current on Vaccines
Yes
No
Tested for Heartworm annually and on Seasonal Prevention?
Yes
No
If "No" to any of the above, please explain why:
What happened to this animal?
Pet Name (Second)
Breed
Age
Spayed/Neutered
Yes
No
Current on Vaccines
Yes
No
Tested for Heartworm annually and on Seasonal Prevention?
Yes
No
If "No" to any of the above, please explain why:
What happened to this animal?
Pet Name (Third)
Breed
Age
Spayed/Neutered?
Yes
No
Current on Vaccines
Yes
No
Tested for Heartworm annually and on Seasonal Prevention?
Yes
No
If "No" to any of the above, please explain why:
What happened to this animal?
I have a veterinarian:
*
Yes
No
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:
*
A fenced in yard
A stationary tie-out
An outdoor run
Invisible fencing
A dog house
If a fenced in yard, what type:
Six-foot wood privacy
Five-foot chain link
Three-foot picket fence
Other
When I am NOT home, or not able to supervise my dog, my pet will be:
*
In the yard
In the garage
Loose in the house
In a designated room
Crated in the house
During a workday 24-hour period, my pet would be alone (Number of Hours):
*
My adopted dog needs to get along with other dogs:
*
Yes
No
Or cats/other animals
*
Yes
No
A member of my household is allergic to dog hair/animal dander:
*
Yes
No
If yes, who:
Ref. 1 Name:
*
Ref. 1 Phone:
*
Ref. 2 Name:
*
Ref. 2 Phone
*
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.
*
Yes
No
I
*
Accept
Decline
Type Full Name:
*
Date & Time:
*