Adoption Application – Dog Adoption Application Primary Applicant Name First Last Phone*Email* Secondary Applicant Name First Last Any additional responsible adults need to be listed in this section - this could be a spouse, domestic partner, adult child, etcPhoneEmail Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Years at this address:Persons in Household* Please list full names and ages of any other adults living in the house. This includes renters.Does anyone in your home have allergies? Please explain*Are you applying for a specific dog?*YesNoDog's Name:*What type of dog are you wanting?*PuppyAdolescentAdultSeniorHospiceSpecial Needs - BehaviorSpecial Needs - MedicalPlease choose all that applyWhat characteristics do you prefer in a dog?*MaleFemaleShort HairLong HairSpecific colorSpecific breedNo preferencePlease choose all that applyWhat personality do you desire in a dog?* Energetic Athletic Cuddle Bug Bashful Non-Chalant Couch Potato Dog Playmate Human Kid Lover Guard Dog Social Bug What exercise level do you desire to have with your dog?* Back yard alone Back yard w/ human Long walks Running Short Strolls Hiking/Climbing Dog Park Agility or Dock Diving What type of residence do you have?*HouseApartmentCondoDuplex / Multi UnitMobile Home - rental propertyMobile Home - owned propertyDo you own or rent your residence?*OwnRentStaying with Friends or FamilyHousing with Others*Please explain. Is this temporary or permanent? If temporary, please explain further.Does your property managment or HOA rules restrict the type or number of animals allowed?*YesNoAnimal restrictions:*Please explain restrictions and or covenants. Home Description* Cats Dogs Children Fenced Yard Other animals None of the above Children Information*Please list name(s) and age(s) of all children in household. Yard Information*Please describe height and type of fence. List water sources such as marsh, lake, pool. Pet & animal Information*Please list name(s) and age(s) and species of all animals in household and on property (eg farm animals; you may just list general information for numerous farm animals)Pet Vetting Information*Are your pets spayed/neutered? Please explain if no. Are they up to dates on vaccines or have you run titers? Veterinary Reference*Please give us the name, address, and phone number of your veterinarian. References will be checked.Will this be an outside or inside dog?*Please explain.Tell us why you want to adopt this dog:* Tell us what qualifies you to be a dog parent:* Where will your dog be during the day?*Please explain.Where will your dog sleep?*Please explain.How long will your dog be left alone during the day?*Please explain.What arrangements will you make if you need to be gone for a long period of time or go out of town?* What type of exercise and enrichment activities will you provide for your dog?* How much do you antipate budgeting each month for your dog? What happens if the dog gets sick and needs emergency care?* What will happen to the dog if you need to move or relocate?* What type of training methods do you use and/or feel are best? What tools will you utilize?* Please be specificPlease describe experience with dogs having special needs or medical needs if applicable* EmployerPhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Reference*Relationship*PhoneReference*Relationship*PhoneBackground Information* Animal Cruelty &/or Neglect Domestic Abuse Dangerous Crimes No prior or pending convictions All fosters and potential adopters may be required to complete a criminal background check. Please click if you have pending or existing charges, convictions or expungements of any of the following.Please explain any pending or existing charges, convictions, or expunged circumstances* Drivers License # & State*Please include any relevant information that you think will help us in screening your application!Electronic Signature*Please enter your legal name. By entering such you agree this constitutes as your legally bounding electronic signature, and you agree that all information completed in this form is true and correct to the best of your knowledge.Date*