PO Box 1465 Gun Barrel City, TX 75147 Phone: 903-479-3497

www.straydog.org

Adoption Application

Email: Fax: 972-692-5168

Name of dog: _____________________ Today’s Date: ____________________

The mission of Straydog is to enrich the lives of our animal friends who may be without shelter, food, care or love; regardless of age, natural beauty or condition. Our animals are living beings entrusted to our care. It is our responsibility to find the best possible homes for them and to meet their individual needs. We reserve the right to approve or deny any adoption as we see fit.

· What is your occupation? ____________________________________________

· Name/location of employer__________________________________________

___________________________________________________________________

· How long is your work day? _______________

· How many hours per day will the dog be alone? _______

· Where will the dog be kept during the day? ____________________________

· If you travel, how often and for how long? ___________________________________________________________________

· When you are away, who will care for the dog? ________________________

· If you lost your job or had to move, what would you do with this dog? __________________________________________________________________

· If this dog grows larger than you expect, what will you do? _________________________________________________________________

· Where will this dog be kept during bad weather? _________________

· What percentage of time will this dog spend: Indoors _____ Out ____

· Where will the dog sleep at night? _______________________________

· How do you plan to housetrain this dog? Paper/puppy pads ___ Consistent praise for going outside ____

· If this dog develops behavioral problems such as chewing, digging, etc, what measures will you take? _______________________________________________

· Will you crate train this dog? _____

· Will you obedience train this dog? _____ If so, how? ______________________

· Do you plan to spank, swat, or in any way physically punish this dog? ______

· Do you plan any physical alterations? _____

Ear cropping _____ Tail docking _____ Other _____

· Please check all equipment below you plan to use for this dog: collar ___ ID tag ___ tattoo ___ microchip ___ crate ___ dog run ___ dog house ___ electric fence ___ invisible fence ___ chain ___ ground tie-out ___ doggy door ____ dog bed ____ bark collar ____

· How long do you plan to keep this dog? ____________________________________

· Would you agree to take your companion dog to the veterinarian for yearly check-ups and keep him or her on heartworm preventative for life? ________

· May we contact your veterinarian for a reference? _______________

Clinic Name: _________________________________________________________

Vet’s Name: __________________________________________________________

City: ______________________________ Phone: ___________________________

Have you ever surrendered, given away or given up an animal? ____________

To whom did you give the animal? _______________________________

If so, describe the circumstances in detail:

Why do you want to adopt a companion animal?

Companion for me ____ for child ____ for other pet ____

Protection ____ Gift ____ Other ____

If other, please explain: __________________________________________________________________________________

About your Home:

I live in a: House___ Apartment___ Condo___ Mobile Home____

How long have you lived at your current address? ___yrs/mos

Please list previous addresses going back 5 years:

Do you plan to move in the next 12 months? ____

Please check one: Own _____ Rent ____

If you RENT your home, are pets allowed? ____

Is there a weight limit? ____ What is the weight limit? ____

Is a pet deposit required?____

Amount? _____

Name of Landlord/manager: ______________________

Phone #: ________________________________________

Do you have a fenced yard? ____ How high is the fence? ____ Is it: chain link / wood? Is your fence secure? ____

Is your fence a common fence with neighboring dogs? _____

Household Information

Total # of adults in household: ____ Please list.

Name: _______________________________ Relationship to you: __________

# of children in household: ____ Please list.

Name: _______________________________ Age: ______________

Do children/grandchildren visit your home? ____ How often? ____________

What are their ages? _________________________________

Current/Past Pet Information (use back for additional pets)

Please list all current and previous pets in your care for the past 10 years:

1. Name of Pet _______________________ Breed: Dog / Cat / Other _________

Age: ______ Spayed/Neutered? ______ On heartworm preventative? ________

What brand of heartworm preventative? ______________________________

How long have you had this animal? ______ Do you still have this animal? _____

If not, why? _____________________________________________________

How/where did you acquire this animal? ___________________________

This animal stays: indoors __mostly indoors __outdoors __mostly outdoors_____

This animal is mostly: dominant ___________ submissive ____________

2. Name of Pet _______________________ Breed: Dog / Cat / Other _________

Age: ______ Spayed/Neutered? ______ On heartworm preventative? ________

What brand of heartworm preventative? _______________________________

How long have you had this animal? ______ Do you still have this animal? _____

If not, why? ______________________________________________________

How/where did you acquire this animal? ____________________________

This animal stays: indoors __mostly indoors __outdoors __mostly outdoors_____

This animal is mostly: dominant ___________ submissive ____________

3. Name of Pet _______________________ Breed: Dog / Cat / Other _________

Age: ______ Spayed/Neutered? ______ On heartworm preventative? ________

What brand of heartworm preventative? _____________________________

How long have you had this animal? ______ Do you still have this animal? _____

If not, why? ______________________________________________________

How/where did you acquire this animal? ______________________________

This animal stays: indoors __mostly indoors __outdoors __mostly outdoors_____

This animal is mostly: dominant ___________ submissive ____________

Do you have experience with Special Needs companion animals? ______

Please explain in detail on the back of this sheet.

I CERTIFY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT. I UNDERSTAND THAT PROVIDING FALSE INFORMATION OR WITHHOLDING INFORMATION ON THIS APPLICATION CAN BE CONSIDERED A VIOLATION OF THE ADOPTION AGREEMENT AND RESULT IN STRAYDOG RECLAIMING THIS PET.

Applicant Signature: ____________________________________________Date: __________

[Straydog Use Only: Counselor ______________approved/denied; Reason: ___________]