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Dog Adoption Application
Contact Info
   
First Name: *
   
Last Name: *
 
 
Street Address: *
 
City: *
 
State/Province Select: *
  Select state/province from list
 
Postal Code: *
 
Phone Number: *
Phone Type: *
   
Alternate Phone: *
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Household Info
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If you rent, please tell us your landlord’s name and phone number:
* How many children live in the home, and what are their ages?
   
* How many hours each day will the adopted animal be without human companionship?
Adoption Info
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* Otherwise, describe in detail the type of dog you're looking for:
   
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If other, please explain why you want this dog:
 
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If no, please explain why not:
   
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If no, please explain in detail:
 
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* Please provide one reference that is NOT your vet or someone living in your home (name AND phone number please):
   
* Please provide your veterinarian's information - name and phone number (after submitting this form please CALL your vet & give them your permission to speak to us):
Previous Pet Info
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If yes, please explain further:
   
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If yes, please explain the circumstances:
   
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