The dog's name you are interested in adopting

Your Name

Spouse/significant Other

Street

City, State, Zip Code

Nearest Airport

Day Phone

Evening Phone

Best Time to Call

E-mail Address

Number of adults in household and ages

Ocupation of adults in household

Are you married

Number of children in household and ages

Are you agreeable to a home visit as a condition to adopting?

If no, please explain

Do you or anyone in the home have any alergies?

If yes, have you discussed with your physician the risk of bringing a dog into the home?

Please explain and list the type of allergy

Are you expecting a child, or planning a family in the future?

If yes, will this affect any of the living conditions of the animal you are wanting to adopt?

Do you own or rent?

What type of Dwelling

If you rent, do you have the landlord's permission to keep a dog?

If yes, please list name and phone number of landlord

How large is your yard?

Is it securely fenced? yes { } no { } Can children open the gates? yes { } no { }

If yes, type of fence, gates, and height

If the yard is not securely fenced, are you willing to make improvements?

Do you have a pool? yes { } no { } If yes, is it securely fenced? yes { } no { }

Do you have a dog run? yes { } no { } If yes, is it secure? yes { } no { }

Are you aware of any dangers that could harm your dog, inside the yard?

Can strangers gain access to your yard from the street?

Where will the dog sleep?

Where will the dog stay when alone? and how long will it be alone?

Do you plan to use a Crate? Why or why not?

Breed/Name

Age

Spayed or Neutered?

Have you ever had to give up a pet? If so, please tell us why?

If you have other dogs, how would you consider them to other people?

Agressive { } Submissive { }

To other animals? Agressive { } Submissive { }

If you have birds, cats, etc., are you prepared to spend the necessary time to accustom them and the dog to each other?

What type of behavior(s) do you expect from your adopted dog?

What amount of time and effort do you want to devote to training your dog?

Are you likely to enroll your dog in obedience class?

What is your definition of disciplining a dog?

What are your training objectives?

What makes you a good pet owner?

Reference #2:

Reference #3:

Please read the following carefully:

I declare that the information I have provided in this application is complete and correct. I understand that falsely provided information can mean that my application will be terminated. I further declare that I am financially and physically able to care for a dog. I understand that proper food and veterinarian care may be costly, and I am able and willing to meet the needs of my adoptive dog. I understand the requirement and grant permission for Home Checks at random both prior to and following adoption. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, Bond County Adopt-A-Pet reserves the right to either refuse adoption or to nullify the adoption and reclaim dog from my premises, without reimbursement of the adoption donation. I release Bond County Adopt-A-Pet from any liabilities I may incur from the adoption process.

Signature/Date: