Dog Adoption Application Form
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1
2Adopter initial(s)
Dog Adoption Application
Animal Ref. ID, if known____________Description _____________Cage#, if known _______________
Name _____________________________ Email address_____________________________
Address _______________________ City____________________________
Home Phone______________ Cell Phone_________________ Work Phone________________________
Place of employment ______________________________ If you travel for work have you made plans for care of your pet while you
are away?
Yes
No
How will the pet you adopt be used?
Pet for you at your home
hunter/guard dog
Gift for someone in your home
Gift for
someone at another home
Where will your pet live?
Always Outside
Always inside the family living area
Primarily outside with access to garage or utility
area
Primarily outside with access to family living area
Primarily inside family living area with access to outside
Who will be the primary person responsible for the care and cost of your new pet? __________________________
Please list the number and ages of people in your household: _______________________________________________________
How many hours per day will this dog be left alone? ___ Where will this dog stay when you are not at home?
_____________________ Where will the dog sleep? _________________________________
Do you live in a house a:
House
Townhouse
Condominium
Apartment
Mobile home
Do you have a fenced in yard?
Yes
No If yes, what type and height? ___________________________
If you do not have a fence how will you exercise this dog and allow it to go to the bathroom?_______________________________
Do you own or rent your home? _________ If you rent your home or property, have you obtained permission from the landlord to have
a pet?
Yes
No
Are you planning to move?
Yes
No If so, are you able to make sure the pet can go into the new residence?
Yes
No
Is shedding a concern?
Yes
No Does anyone in the home have allergies?
Yes
No
What energy level are you looking for?
High
Medium
Low
How will you train your pet or correct inappropriate behavior? ______________________________________________________
Please complete the section below for any and all pets that you have had in the past 5 years:
Type/Species
Breed
Sex
Spayed/Neutered
Where is the animal
now?
Have you ever given an animal to a shelter before?
Yes
No
If yes, name of shelter and what were the circumstances? _____________________________________________________________
Do you understand that rabies vaccinations AND city or county animal licenses for dogs are required by law everywhere in Virginia?
Yes
No
Do the pets you already own have current rabies vaccinations?
Yes
No
Do the pets you already own have current animal licenses?
Yes
No
Not required (Some localities do not require CAT
licenses.)
The Approval of this adoption application will be based on what is in the best interest of our shelter animal(s)
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