You Must Be 21 Years Old and Have a Valid Driver's License Or Picture ID to Be to Adopt

Save A Dog

Adoption Application

You must be 21 years old and have a valid driver's license or picture ID to be to adopt.

Date: ______

SECTION 1: PERSONAL INFORMATION

First Name: ______Last Name: ______

Address: ______

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City: ______State: ______Zip+4: ______

Home Phone: ( ) ______Cell Phone: ( ) ______

E-mail Address: ______

(required to be notified of dogs available) (PLEASE PRINT CLEARLY)

Occupation: ______

Dog Interested in: ______

Have you applied with other dog adoption agencies? If so, let us know if the home visit is complete. ______

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SECTION 2: DOG INFORMATION

Is this application for one or more of our currently available dogs? Yes _____ No _____

If Yes, Please list the names of the dog or dogs for which you are applying:

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If No, please let us know what type of dog you are looking for. If you have a preference as to

sex and size, please indicate that also.

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What is the OLDEST age dog you will accept? : ______

Any age is acceptable: _____

Will you accept a dog that has treatable medical problems, i.e., needs pills? Yes ____ No ___

Maybe ______with the following conditions

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SECTION 3: ENVIRONMENT FOR DOG

Do you have a completely fenced-in back yard on your property?Yes ___No ___

If you have no fence, how do you plan to have your new dog receive proper exercise?

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Do all adults work full time?Yes ___No ___ Opposite hours ___ Flex hours?____Work from home___

How many total hours each day will your new dog be alone?_____ Hours

How will you structure the dog’s time when s/he is alone? Will you use a dog walker or daycare? Please provide name of dog walker or daycare.

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Will you be feeding dry kibble and if so, what brand; If a raw diet please indicate so.

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Are you aware that certain pet food companies put euthanized pets and road kill in their food? Are you willing to take our recommendations on dog foods that are safe?

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Obedience training is mandatory for our adopted dogs. Do you have a trainer lined up? If not, do you need a referral?

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Are there any medical conditions or mental or emotional issues that might prevent you or your family members from caring for a dog on a permanent basis? If so, please explain.

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SECTION 4: REFERENCES

Please provide the contact information of a veterinarian you have used before and plan to use with your new dog? Vet references are checked.

Vet Name: ______Vet Phone:( )______

Vet records are under the name of: ______

Please provide at least two personal references, preferably your dog trainer, pet sitter, groomer or someone who knew your previous dogs, or if you’re a first time dog owner, the name of someone whose dog you have cared for. Include their name, telephone # and how this person knows you and your ability to provide a good home for a dog:

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SECTION 5: HOUSEHOLD INFORMATION

Please list place of employment for yourself and your spouse, if applicable. Include the location of each employer.

My Employer is: ______

Spouse’s Name: ______

Spouse’s Employer: ______

Residence: Own _____ Rent _____

Please note: If you own, proof of ownership will be required for the adoption process.

If you rent, you must provide your landlord's contact information below so that we may verify that you are allowed to have a pet.

Landlord’s Name, Address, Phone Number: ______

______

Total number of people living in your residence (including yourself): ______

Do you have 1 or more cats? : Yes _____ No _____

List below all people who currently live at this residence, including yourself (children’s names not required, you can put daughter/son/grandchild):

Household MemberRelation to youAge

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Does anyone in your house have any known allergies to dogs? Yes ___ No ___

List below any cats, dogs, etc. who currently lives in your household:

How long Kept

Name Type/Breed Age? Sex/Neutered? Owned? Where?

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SECTION 6: HISTORY

Have you owned a dog before? : Yes ______No ______

If yes, please provide a brief history of what happened to it. If your last dog died, please state dog's name and date deceased.

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SECTION 7: DONATION INFORMATION

The adoption donation ranges from $350-425 for adult dogs and $450-550 for puppies. This cost is to cover increasing transportation costs and extra health certificates for our dogs. Out of state dogs receive a medical exam and health certificate prior to transport and also after the 48 hour state-mandated quarantine. Are these terms acceptable?

Yes _____ No _____

Please realize that dogs need vet care throughout their lives. If you cannot afford this donation, you may not be able to afford the appropriate vet care. Please consider this before adopting a dog.

Are these terms acceptable to you? If so, please indicate by signing below:

I certify that I have read the above Adoption Application and donation information and will execute same promptly upon receipt. All medical records and other pertinent information will be provided to you upon receipt of above.

Signature: ______

Print name: ______Date ______

Please return this application by email to or fax our toll-free fax number, 877-349-9254 or mail to:

Save A Dog

604 Boston Post Road

Sudbury, MA 01776

If you have any questions, please call: Save A Dog at (978) 443-7282.