Dog Adoption Application

Welcome to Pets Alive’ Adoption Program. The following information is requested
so that we can assist you in the selection of a new dog. This form and a consultation
with a Pets Alive representative are designed to help you find the dog most compatible
with your lifestyle.

In order to be considered as an adopter you must:

• Be 21 years of age or older.
• Have identification showing your present address.
• Have the knowledge and consent of your landlord.
• Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet.

Completion of this application does not guarantee adoption of a Pets Alive dog.

Thank you!

* Denotes required fields

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Name: *
Address: *
City: *	State: * --- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: *  Zip + 4:
Phone: *
Email: *
Age: *
Describe in detail the dog you're looking for *:
Would this be your first dog? *
--- Yes No
What kind of pets have you had in the past *:
Which of these do you still have? (Include age, sex and breed)*
Have they been spayed or neutered? *
--- Yes No Don't Know
Are they current on vaccinations? *
--- Yes No Don't Know
What happened to the ones you no longer have? *
Have you ever turned your dog in to a shelter? *
--- Yes No
If yes, please explain:
Have you had a pet euthanized?*
--- Yes No
If yes, please explain:
If you have other pets will they (or it) adjust to a new pet entering the household? *
Was your last dog obedience trained? *
--- Yes No Doesn't Apply
Why do you want this dog? *
--- Companion Companion for other pet House Pet Watch Dog Guard Dog hunting Personal Protection Other
Other reason details:
How many adults are there in your family? *
How many children? * Children’s ages
Does any member of your household have an allergy to dogs? *
Is someone home during the day? *
--- Yes No         Who?
How many hours each day will the dog be without human companionship? *
Explain:
Which do you live in?*
--- House Apartment Condo Mobile Other
If other, explain:
Do you own or rent your home? *
--- Own Rent
If you rent, may we contact the owner to obtain permission for this animal to live in your home?*
--- Yes No
Owner's name and phone number:
Name Phone
Do you have a completely fenced yard?*
--- Yes No
What kind of fence? Height ?
Is there a gate?    --- Yes No
If not, explain:
Do you have a dog door? * --- Yes No
Are there times when the dog will be tied up? * --- Yes No
If yes, when?
Are there stairs that lead to your home? * --- Yes No
If yes, how many?
Will the dog spend any time in the garage? * --- Yes No
If yes, explain
Do you have a pool? * --- Yes No
If yes, is there a fence around the pool? --- Yes No
If your new dog/puppy is not housebroken, what method will you use to train it? *
Will you keep the dog up-to-date on vaccinations? * --- Yes No
Who is your veterinarian? *   City *: Phone: *
Would you be able and willing to exercise the dog on a regular basis? * --- Yes No
Method:
Where will this dog be kept during the day? *
During the night? *
If you drive a pickup truck, would you allow the dog to ride in the back? * --- Yes No
If you go away for a few days, or on a vacation, who will take care of the dog? *
If you move, will you take the dog with you? * --- Yes No
Explain
How much are you willing to spend on medical bills for your dog? *
--- up to $100 up to $500 up to $1000 up to $5000 Whatever it takes
What would you do if the vet bills go over this amount? *
Have you ever applied to adopt an animal from Pets Alive in the past? If so, when? *
--- Yes No       Details:
Did anyone refer you to Pets Alive? *   --- Yes No
If yes, please explain:
Have you ever attended a Pets Alive mobile adoption? * --- Yes No
If yes, where was it?
Are you willing to allow a Pets Alive representative come to see where the dog will be living?*
--- Yes No
Are you willing to take the responsibility for this dog for the next ten to fifteen years? *    --- Yes No
What provisions will you make for the dog should you become unable to care for it? *
Is there anything else you would like us to know?