Canine Adoption Form

Date / Time Submitted________________

Staff Initials_________________

Please email to

, or mail to: 1355 N.E. Hemlock Ave., Redmond Or 97756, or fax to:

541-923-8609

Submitting this application is not a guarantee for adoption.

Applicant name:

Applicant occupation:

Applicant age:

Applicant Driver’s State/License:

Spouse/Partner name

(if applicable):

Spouse/Partner occupation

(if applicable):

Spouse Age

Address:

City: State: Zip:

Phone:

Email address:

Canine being considered:

1. Please tell us the name, address and telephone number of your current veterinarian or the one you

plan to work with should your adoption application be approved.

2. Do you currently own any animals? If yes, please tell us about them. We would like to know their age,

gender, breed, size and general temperament towards other animals.

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Parent category: Legal