|
|||||||
|
|
|
|||||
|
|
|||||||
If you are seriously interested in one of our dogs please fill out the form below.
Please copy and paste the form into a blank email, fill out, and email to me at wyattmonk@aol.com
If you already have an interview appointment you may bring the form with you instead of emailing it.
Date:
APPLYING FOR:
Name of Animal:
APPLICANT'S INFORMATION:
Full Name:
Address:
City:
State:
Phone Number:
Age:
HOUSEHOLD INFORMATION:
Where Do You Live? (Please circle one)
House
Condo/Apt.
Mobile Home
Student Housing
Military Housing
Neighborhood (Please circle one): Urban / Suburban / Rural
How long at your present address?
Do you have a fenced property?
Do You Own Your Own Home? Y/N (If yes, please provide proof of ownership.)
Do you rent? Y/N
If yes,
Landlord's Name:
Landlord's Phone Number:
Are you planning to move within the next year? Y/N
If yes, what are your plans for your companion animal when you move?
If you decide to move in the future, what will you do with your companion animal?
What provisions have you made for your companion animal in the event of your illness or death?
How many adults in your home?
Are there children in your home? Y/N
If yes, how many and what are their ages?
Are all members of your household aware of your plans to adopt an animal? Y/N
Are any members of your household allergic to animals? Y/N
Where will your companion animal sleep?
How many hours will your companion animal be alone?
Who will be responsible for the animal?
Does anyone in your household smoke? Y/N
If yes, where?
Do you have any health conditions which could restrict your ability to care for an animal? Y/N
If yes, please describe:
VACATION:
How often do you go on vacation?
What will you with your companion animal when you go on vacation?
EMPLOYMENT:
Employer:
Occupation:
How long at your present job?
Can you be contacted at your job? Y/N
If yes, work phone #:
OTHER ANIMALS:
Do you have cats? Y/N
If yes,
How many? Do the cats live strictly indoors? Y/N
Are the cats declawed? Y/N
Do you have dogs? Y/N
If yes,
How many?
Do dogs live indoors? Y/N
Other animals? Y/N
If yes,
How many?
Describe living conditions of other animals:
Are all animals in your household spayed/neutered? Y/N
Name of Veterinarian:
Address:
Phone Number:
If no companion animals at this time, have you had any in the past 8 years? Y/N
If yes, what happened to them?
REFERENCES:Please list people other than family who you have known for at least 5 years.
Name:
Phone Number:
Name:
Phone Number:
Name:
Phone Number:
QUESTIONS: (Use back of application to answer)
Why do you want to adopt an animal?
What type of personality are you looking for?
(If applicable) Have you ever had a special needs animal before? Y/N
If yes, describe:
If necessary, how will you discipline the animal?
Are you aware of the expenses that may incur in owning an animal such as grooming, medications and medical bills that may arise?
I hereby certify that all information supplied by me on this application is true.
Signature:
Date:
********FOR OFFICE USE ONLY********
Reviewed by:
Date:
Driver’s license or other formal ID Verified: Y/N
Housing verified: Y/N
Date:
Comments:
Landlord Approval: Y/N
Date:
Comments:
Veterinary Reference Checked: Y/N
Date:
Comments:
***Final Approval***
YES / PENDING / DENIED
Date:
Animal Description:
Sex: M/F
Age:
Animal's new name: