Dog Adoption Form Date
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1
23173 Highway K68
Ottawa, KS 66067
Phone: (785) 242-2967
Fax: (785) 242-7151
Email:
Website:
Dog Adoption Form
Date____/____/____
Dog Name/Description______________________________________Dog ID #___________
Name_______________________________________________________________________
Address_______________________________________State/Zip______________________
Home Phone______________Cell/Work___________E-Mail__________________________
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Mobile Home □ Other
Do you:
Own
Rent Do you live in:
House
Apartment
Condo
If renting, please provide Landlord Name & Number___________________________
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13 yrs & older □ None
Children in Household/Visit:
1-4 yrs
5-8 yrs
9-12 yrs
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Are you moving within the next year?
Yes
No If Yes, will you take the dog with you?
Yes
No
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Is anyone in the home allergic to dogs or cats?
Yes
No
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Have you ever relinquished an animal to an animal shelter or individual?
Yes
No
If yes, please explain:____________________________________________________________
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Have you adopted any pet(s) from a different shelter?
Yes
No If yes,
Where?________________________________________________________________________
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Have you ever adopted from the Bea Martin Peck Shelter or Prairie Paws?
Yes
No
If so, when?____________________________________________________________________
Please indicate the importance of the following with respects to a new dog:
Very Important
Important
Not Important
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Friendly with Children
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Friendly with Dogs
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Friendly with Cats
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Friendly with visitors to
the home
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Enjoy being groomed
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Enjoy being held
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Enjoy being petted
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Calm
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Active
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Playful
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Independent
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Quiet
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Parent category: Legal