- ADOPTION AND FOSTER APPLICATION - 
 Date: _______________  Name: ___________________________________  DOB: _______________  Driver’s License #: _________________________  Address: ____________________________________  City: ______________  Zip: __________  Length of Residency at Above Address: ____________________  Home Phone: _______________  Email Address: ________________________________________________  Employer: _______________________________________  Job Title: ______________________  Work Phone:  ________________  
1.  I am looking to: [Adopt, Foster]  2.  I am interested in: [List a specific dog or indicate ‘undecided’]  3.  If undecided: are you looking for: [Puppy, Dog, Either]  4.  Would you prefer a: [Female, Male, Either]  5.  Is this pet for a gift? [Yes, No] If yes, list name of recipient and their age  6.  Reason for wanting a pet (list as many as apply): [Watchdog, Child’s Pet, Companion, Breeding, Family Pet, Hunting, Companion for other pet, Other]  7.  Would this pet be: [Inside, Outside, Inside/Outside]  8.  If outdoors, what type of shelter would you provide? [Describe]  9.  Where would this animal sleep? [Describe]  10.  Where will you keep your pet while gone? [Describe]  11. Number of members in household: [List]  12.  Name(s) and date(s) of birth if other adult(s) in household (if applicable): [List]  13.  Ages of children in household (please include even if only occasionally in residence: [List]  14.  Have you or any member of your household been convicted of a crime against animals? [Yes, No]  15. Other pets (please list type, how many, ages and where housed): [List]  16. Have you had pets in the past (other than listed above)? [Yes, No] If yes, where are they now? [Describe]  17. Name and phone number of Veterinarian: [List] 18. Will you spay or neuter this pet? [Yes, No]  19. If this pet becomes ill or injured, are you able and willing to spend $500 or more for veterinary care: [Yes, No]  20. Do you or anyone in your household have allergies or asthma? [Yes, No] If yes, please explain:  21. Which of the following best describes your home? [House, Apartment , Condo, Farm, Mobile, Dorm]  22. Do you? [Own, Rent] If you rent, does your landlord allow pets? [Yes, No]  23.  Do you have a fenced yard?  [Yes, No]   24.  How do you plan to exercise a new dog?  [Describe] 25. Name, address and phone number of two references [List]    |