Waifs & Strays Animal Rescue

DOG ADOPTION APPLICATION

Name of pet you are applying for: ______Date:______

Applicant/Co-Applicant Information

Last Name: ______First Name: ______DOB: ______

Last Name: ______First Name: ______DOB: ______Address: ______Apt #______

City: ______State: ______Zip: ______County: ______

Home Phone: ______Cell Phone: ______Email Address: ______

Do you own? ______Rent? ______Landlord’s Name: ______Phone: ______

How long have you lived at this address? ______Any plans to move in the near future? ______

Family/Household Information

Number of adults in the household:______Relationship:______

Have all the adults in the household agreed to this adoption?______

Number of children in the household:______Ages of children:______

Have the children had pets before?______Do you expect your current family situation to change?______

Is there a Daycare or Daily Baby Sitter at the Household?______

Is anyone in the household allergic to pets?______If yes, who?______

What are your reasons for adopting a pet? (Check all that apply)

( ) Companion for self ( ) Companion for other household member ( ) Gift ( ) Watchdog

( ) Companion for child ( ) Companion for other pet ( ) Other (explain)______

Employment Information

Employer:______Position held:______

Address: ______

Work phone:______How long have you been with this employer?______

Pet Information/Please list current pets:

NAME BREED AGE SPAYED/NEUTERED?

1 ______M / F ______

2 ______M / F ______

3 ______M / F ______

4 ______M / F ______

Have you ever given an animal away or relinquished an animal to a shelter?______

If yes, what were the circumstances?______

______

Have you ever lost a pet?______Has a pet been hit by a car?______Have you had a pet euthanized?______

Explain any “yes” answers:______

______

Are your current pets up to date on vaccines and on monthly heartworm preventative? ______

Veterinarian/Clinic Name:______Phone:______

New Pet Information

Are you aware it can take up to 5 months (some longer) for a new pet to adjust to his/hers new environment?______

How much time are you prepared to allow for your new dog to adjust to your home?______

How much do you expect to spend on maintenance for your dog in a year?______

Are you committed to providing a responsible, loving home for your dog’s entire life (15+ years)?______

If you have to move, what do you plan to do with your pet(s)?______

Who in the household will be the dog’s primary caregiver?______

When you are out of town, who will be the dog’s primary caregiver?______

In case of emergency, who will care for your dog?______

How many hours per day will your dog be left alone?______

Where will the dog be kept during the day?______At night?______

How do you plan to house-train your dog?______

Will you attend dog obedience classes? ______

How will you reprimand your dog for chewing, digging, house-training mistakes or mischievous behavior?______

______

What type of food and how often will you feed your new dog?______

How often and where will you exercise your dog?______

Do you have a COMPLETELY fenced yard?______If yes, what type/size?______

What would you do if your dog develops a problem with:

Chewing: ______

Barking: ______

Digging: ______

Separation Anxiety: ______

Aggression: ______

References - Please list 3 personal references below.

1 ______

(Name)(Relationship) (Phone Number)

2______

(Name)(Relationship) (Phone Number)

3______

(Name)(Relationship) (Phone Number)

By signing below, I certify that the information I have given is true. I understand that Waifs & Strays Animal Rescue reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application and the release of any and all medical information history of previously owned pets.

Applicant:______Date:______

Co-Applicant:______Date:______