A Few Steps From Home Dog Adoption Application

Name: Spouse Name:
E-Mail:
Date of Birth:
Address Line 1:
Address Line 2:
City:
State:
Country:
Home Phone Number: Date of application submission:

Cell phone number (if Applicable)

Work Phone Number: If needed may we contact you at work?

Name of animal you are applying for. (if animal is not on web page, please be specific on breed, size, and age of the animal you are looking for) We will try to locate the right one for you!

Have you owned this type/breed of animal (dog, cat, etc.) before? YesNo

How many pets do you currently own?

Please list:

How many animals have you owned as an adult? name, breed, size, age, what happened to the pet(be specific):

Please provide the names and phone numbers of three personal references. Please include one neighbor, if possible. Please do NOT include family members/relatives:

    Name: Phone:

    Name: Phone:

    Name: Phone:

    Veterinarian where your pets records are: Veterinarian phone number and address:

    Can you afford regular veterinary care for the new pet? YesNo

    Do you agree to have annual checkups and all vaccinations administered by a licensed veterinarian? YesNo

    How many children are in your household and what are all of the ages?

    If you don't currently have children, are you planning on having children in the future? Yes No Maybe

    If you did have children at a later date, would this make you want to give up your pet?

    If you have young children, they need to be educated on how to interact with the dog in order to prevent dog bites, are you able/willing to do that? NoYes

    How many adults are in your household?

    Who will be the one looking after your new pet?

    Are other members of your household in agreement with the adoption?YesNoNot sureHaven't discussed it

    Where will the dog be left when alone?

    How many hours will your dog be left alone a day?

    Do you plan on doing obedience training with your new animal? YesNo Maybe

    What are your feelings about crating the animal?

    Do you have a fence?

    what kind do you have

    How high is the fence?

    If you do not have a fence how will the dog safely be let out to relieve itself?

    What form of discipline will you use? What have you used in the past with other pets?

    Do you or have you ever bred animals?

    If you do currently breed animals or have bred in the past,please explain:

    What would make you want to give up on a dog? please select the best answer

    If you selected more then one answer from the above question please explain

    Do you realize that you will probably have to housetrain your new puppy/dog? NoYes

    What will you do if your dog shows destructive behavior? (Digging, chewing, jumping, tearing up plants/furniture or running off)

    How long will you give this dog to adjust to its new home

    If your dog ran away what would you do?

    Have any of your animals ever accidently been loose before? How did it happen?

    If you have an animal in your residence now, have you ever introduced it to a new animal?YesNoDon't have other animals

    If "Yes," how did your pet react? FavorablyDifficult AdjustmentIndifferent

    If you move in the future, what will you do with the animal?

    Why are you looking for a pet? How long have you been searching?

    Are you looking for a pet for yourself or someone else? If someone else, please explain who.

    Do you realize that dogs often live longer than 10 years and are you willing to assume responsibility for that long? NoYes

    Are you familiar with heartworm disease? NoYes

    Will you maintain your dog on heartworm preventative? NoYes

    Do you rent or own your current residence? RentOwn
    What type?HouseMobile HomeApartmentCondominium
    If RENTING: Landlord's Name: Phone:
    Will the landlord allow pets?YesNo
    If YES, are there any restrictions?
    Pet Deposit (in U.S. dollars): $

    Comments/Suggestions/Concerns

    Where did you hear about A Few Steps From Home??

    All of the information that I have provided in this application is true and accurate to the best of my knowledge.
    Applicant's Initials:

    No act of kindness, no matter how small, is ever wasted- Thank you for taking the time to fill out our application.

SPECIAL NOTE: Please Fill out entire application to the best of your ability. We MUST have a Veterinarian telephone number and a personal reference listed. Please understand we ask these questions because it is the only way we are able to tell if these animals are a good match for not only the animal but for your family. If you object to filling out any information, we are sorry but you will NOT be eligible for one of our pets. Thank you for your time and understanding.

Copyright 2007 Created by Heather Smith - All Rights Reserved No part of this page shall be duplicated in any way under penalty of law.

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