Dog Adoption Form Personal Questions First Name* Last Name* Physical Address* Where your new dog will live Physical Address (con't) City* State* -- Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code* Email address* Primary Phone Number* Example: 555.123.4567 Secondary Phone Number Example: 555.123.4567 What is your age?* Do you own or rent?* Own Rent Live with Parent(s) or Relative(s) Live in Dorm, Military Quarters, etc Can you show proof of pet policy?*Proof of pet policy? Yes No Marital Status* Single Married Divorced Widowed What is your spouse's name? Does your spouse also want to adopt a pet?*Is your spouse currently employed? Yes No Please list place of employment (yours or spouse's):* Work Days & Hours: How many children live in your home? 0 1 2 3 4 5 or more Fence/Containment Do you have a completely fenced-in back yard?*Do you have a completely fenced-in back yard? Yes No What type of fence?What type of fence? Privacy Fence Chain Link Fence Farm Fencing Other If Other, Explain: Height of Fence Please check if you have any of the following:Please check if you have any of the following: Outdoor Dog Pen/Kennel Tie-Out Stake and Lead Doghouse Indoor Crate Doggie Door Pet Information Do you currently have pets?*Do you currently have pets? Yes No Do you currently own any dog(s)?*Do you currently own any dog(s)? Yes No Current Dog(s) Name(s), age(s), breed(s), gender(s), spayed/neutered? What type heartworm prevention do you give them?Are all of your dog(s) on heartworm prevention? None Heartgard Interceptor Revolution Trifexis Other Do you currently own any cat(s)?*Do you currently own any cat(s)? Yes No Current Cat(s) Name(s), age(s), breed(s), gender(s), spayed/neutered? Are any of them de-clawed?Are any of them de-clawed? Yes No If any of your current pets are not altered, are you willing to have the animal(s) altered prior to adoption?If any of your current pets are not altered, are you willing to have the animal(s) altered prior to adoption? Yes No N/A Please list PAST pets and why they are no longer with you Name, Dog/Cat, Spayed/Neutered/Why are they gone? Current & Previous Veterinarian(s) Name and Phone Number Adoption Questions Which dog(s) would you like to meet and possibly adopt?* If you intend to adopt more than one, please separate their names with commas. My new dog needs to be good with:*My new dog needs to be good with: Children < 5 Children > 5 Elderly People Cats Dogs Other Check all that describe the dog you want:Check all that describe the dog you want: Couch Potato Intelligent Hunting Dog Goofball Low-Energy Guard Dog Constant Companion Smart, but not smarter than me Working Dog Free Spirit High-Energy Yard Dog Party Animal Lap Dog Senior Citizen My new dog will primarily be an:*My new dog will primarily be an Outdoor Dog Indoor Dog Both Outdoor and Indoor Dog My new dog needs to be able to be alone:*My new dog needs to be able to be alone: Over a weekend >8 hours per day 6-8 hours per day 4-6 hours per day 2-4 hours per day <2 hours per day Hardly ever When I'm not at home, my new dog will primarily spend time:*When I'm not at home, my new dog will spend time: In the garage In a crate inside my home In the yard Loose in my home In one room Free to go in and out through doggie door I would prefer to adopt a:*I would prefer to adopt a: Puppy < 16 Weeks Puppy 4-12 Months Young Adult 1-4 Years Middle-Aged Adult 4-8 Years Senior > 8 Years I am wiling to adopt a dog/puppy who is:*I am willing to adopt a dog/puppy who is Well-behaved Completely trustworthy when left alone in my home Mostly house-trained In need of some obedience training Partially house-trained Still in the chewing stage, might do some property damage Just started housetraining In need of training for EVERYTHING (all young puppies in this category) Not house-trained I am comfortable doing some training to improve manners such as jumping, pulling, etc:I am comfortable doing some training to improve manners such as jumping, pulling, etc? No Would like information on obedience training Yes I have done obedience training My thoughts on house-training are...My thoughts on house-training are... I don't want ANY accidents in my home I will be upset if my dog has accidents, but not the end of the world I don't mind if my new dog has a few accidents in the house during the first few weeks I don't mind the occasional accident I will work with my new dog on house-training as long as it takes I am familiar with heartworm prevention?I am familiar with heartworm prevention? Yes No I would like information about heartworm prevention I am willing to budget $__ monthly to care for my new dog.I am willing to budget $__ monthly to care for my new dog. $25-$50 $50-$75 $75-$100 > $100 (so I will have some for emergencies) Whatever it takes If I experience behavioral problems with my new dog, I'll....If I experience behavioral problems with my new dog, I'll.... Give him or her away Give him or her back to ANLOL Call a trainer Consult my veterinarian Consult A New Leash on Life Please enter your email address again * Once you click SUBMIT, please WAIT several seconds for your form to be checked for errors. If no errors, you will be informed that your form was SUCCESSFULLY SUBMITTED and you will receive an email at the address you listed in this form. If not, please scroll up and check the form for errors, correct them, and click SUBMIT again. We look forward to matching you with a pet...Thank you!. Type the characters* This field should be left blank Send Please wait...
