Dog Adoption Application Form (Page 3 of 4) in pdf

Dog Adoption Application Form Page 3

Where will the dog spend the day? (describe)

_________________________________________________________________________

Where will the dog spend the night? (describe)

_________________________________________________________________________

Number of hours (average) dog will spend alone? _________________________________

Who will have primary responsibility for this dog's daily care? _______________________

Who will have financial responsibility for this dog? ________________________________

Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No

Do you agree to keep the dog as an indoor dog? __Yes __No

When the dog goes out, how do you plan to supervise it? Fenced yard?

Do you agree to contact us if you can no longer keep this dog? __Yes __No

Are you willing to let someone visit your home by appointment?

__Yes __No

Please provide the names of two personal references

Name_________________________________ Phone ___________________________

Name_________________________________ Phone ____________________________

All of the information I have given is true and complete. This dog will reside

in my home as a pet. I will provide it with quality dog food, plenty of fresh

water, indoor shelter, affection, annual physical examination and vaccinations

under the supervision of a licensed Veterinarian.

___________________________

_________

(Signature)

(Date)

Dog Adoption Application Form Page 3