Dog Adoption Form Step 1 of 4 - Applicant Info 25% Date MM slash DD slash YYYY Applicant Name First Last Name of dog you want to adopt (as seen on our website)* Age Spouse/Roommate Name First Last Age Address Street Address City State / Province / Region ZIP / Postal Code (PO box unacceptable) Home PhoneCellWorkSpouse/Roommate HomeCellWorkEmail (both applicants) Living Situation House Apartment Condo Mobile Home Do you own or rent your home? Own Rent How long have you lived at this address? If you rent, please provide name and phone number of landlord or HOA contact person: What is your current occupation? Who is your current employer? Does your job require extensive travel? Yes No How many adults are in your family? Full name(s) if other than adopter(s)How many children? Age(s)Why, specifically, do you want a dog?Will this be your first dog? Yes No Do you currently have pets? If so, list breed, age, sex & temperament (alpha or submissive)Are these pets on heartworm prevention? Yes No Brand Have they been spayed or neutered? Yes No Don't Know Are they current on vaccinations? Yes No Don't Know Was your last dog obedience-trained? Yes No Doesn't Apply Why do you want this dog? (Check all that apply.) Companion Companion for other pet House pet Watch dog Guard dog Hunting Personal protection Other (explain)Name & Phone Number of Your VeterinarianHave you ever surrendered any of your animals to a shelter? Yes No If yes, please explain:Have you ever had a pet euthanized? Yes No If yes, please explain:Is your yard fenced? Yes No What kind of fence? Fence height at highest point? How big is your yard? Is there a gate? Yes No Will gate be locked to protect your dog? Yes No Do you have a dog door? Yes No If you live in Palm Beach County, will you abide by the Palm Beach County anti-tethering ordinance by not chaining the dog? Yes No Does any member of your household have an allergy to dogs? Yes No Is someone home during the day? Yes No If yes, who? How many hours each day will the dog be without human companionship? Where will the dog be kept during the day? At night? Where will the dog stay when the family is out of town? Do you crate your pets? Yes No Are you able and willing to exercise the dog on a regular basis? Yes No If yes, method of exercise:If your new dog/puppy is not housebroken, what method will you use to train him/her?Would you be willing to take the dog to obedience classes? Yes No If no, why?If you drive a pickup truck, would you allow the dog to ride in the back? Yes No If yes, please explain:If you move, will you take the dog with you? Yes No If no, please explain:Are you willing to take responsibility for this dog for the next 10 to 15 years? Yes No If no, please explain:What provisions will you make for the dog should you become unable to care for him/her?UntitledHow much are you willing to spend on medical bills for your dog? Up to $100 Up to $500 Up to $1,000 Up to $5,000 Whatever it takes Have you ever applied to Save A Pet before to adopt an animal? Yes No If yes, when?How did you find out about Save A Pet? Personal Reference 1 First Last Relationship PhoneEmail Personal Reference 2 First Last Relationship PhoneEmail
