.png)
Full Name (including middle name) :
Address:
City:
State:
Zip Code:
Email:
Primary Phone:
Alternate Phone:
Birth Date:
Place of Employment:
Name of the dog that you are interested in:
How long have you lived at your current residence?
If you are not the property owner, we will need to verify your landlord's current pet policy.
Landlord's Name:
Landlord's Phone #:
How many adults live in your home?
How many children live in your home?
Ages?
Does anyone in your household have allergies?
Who will primarily be responsible for the care of this dog?
Which of the following best describes your reasons for wanting this dog?
How many hours will the dog be alone each day?
Where will the dog be kept when no one is home?
Where will the dog be kept at night?
Do you have a fenced yard?
If so, how high is your fence?
Type of fence?
If you have other pets, are their vaccinations current?
Are they currently licensed?
Do you have a regular veterinarian?
Name:
Phone #:
Please list all the pets you have had in the last 7 years, including current pets and those you no long own:
Species | Breed | Age | Sex | Altered? | Owned how long? | What happened to him/her? |
|---|---|---|---|---|---|---|
Please describe the temperament and activity level you are looking for in a dog:
When it comes to relating to dogs, I tend to be more:
The noise/activity in my home is usually:
I would prefer a dog that:
My ideal dog would:
Bad dog habits that I cannot tolerate are:
Reasons I would return the dog:
Please enter your initials in this box to agree to the statement below:
I understand and agree that Dogs Adoption Network makes no express or implied warranty, representation or promise to the age, health, breed, habits, disposition, or safety of the animal. I hereby accept the animal as is, assume all risks and responsibilities associated with the ownership of the Animal (dog), including bites, and I hereby fully and completely release, indemnify and hold harmless Dogs Adoption Network, its directors, officers, volunteers, servants, and employees from any claim, cause of action or liability of any sort or nature, whether known or unknown, directly or indirectly arising out of or in connection with the adoption, care or ownership, maintenance, temperament or condition of the Animal (dog).
Please enter your initials in this box to agree to the statement below:
I agree, in the case I cannot keep the Animal (dog); he/she will be rehomed via Dogs Adoption Network adoption events. The proceeds from the adoption will be kept by the Network for facilitating services. The Animal (dog) will be kept in the care of current owner until new adoption occurs.
Please enter your initials in this box to agree to the statement below:
All monies deposited with Dogs Adoption Network will be considered a donation to the rescue and are non-refundable.
Please enter your initials in this box to agree to the statement below:
I acknowledge falsification of the above can result in me being denied adoption of an animal.
Please enter your initials in this box to agree to the statement below:
I certify that the above information is true and correct to the best of my knowledge.
Signature:
(Type full name)
Date:
Successfully submitted.
An error occurred. Try again later