Personal Information
Name
Date of Birth
Address
City
State/Province
Zip/Postal Code
Phone (Home)
Phone (Cell)
Email Address
Household Information
Are you over 21 years of age?
Number of Adults in Household
Number of Children
Ages
Do any household members have allergies to dogs?
Do you own or rent your home?
If you rent, please provide Landlord's Name and Contact Information
Do you have a securely fenced yard?
If yes, please describe the type and height of the fence
Is your yard securely gated?
Lifestyle and Commitment
Do you have a regular work schedule?
How many hours per day will the puppy be left alone?
How do you plan to exercise and socialize the puppy?
Are you willing to attend obedience training with your puppy?
Have you ever returned a pet to a shelter or rescue organization?
If yes, please explain the circumstances
Have you ever been convicted of animal cruelty or neglect?
If yes, please explain the circumstances
Current and Past Pets
List all current pets (include type, breed, age, and gender)
List all past pets (include type, breed, age, and reason they are no longer with you)
Veterinary Information
Veterinarian's Name
Veterinarian's Clinic
Veterinarian's Phone
May we contact your veterinarian for a reference?
References Please provide the names and contact information of two references who are not related to you:
Reference 1
Name
Email
Phone
Reference 2
Name
Email
Phone
Additional Comments or Information
Declaration I declare that the information provided in this adoption application is true and accurate to the best of my knowledge. I understand that submission of this application does not guarantee approval for adoption. I consent to a home visit, reference checks, and other screening procedures as required by [Breeder's Name]. I agree to abide by the terms and conditions of the adoption contract.
Applicant's Name
Date
Thank you for your interest in adopting a puppy from [Breeder's Name]. We will review your application and contact you if we believe you may be a suitable match for one of our puppies Breeder's Contact Information
Phone
Email
Address
Website
City
State/Province
Zip/Postal Code
SUBMIT
