Adoption Application

Contact Information

Name*

First Last

Occupation

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How long at this address?

Daytime Phone

Evening Phone

Best time to call?

Email*

Enter Email Confirm Email

Family & Housing

List all Family Members that will be living with the dog

Name	Relationship	Age

Click the "+" sign at the end of the row to add family member

Is anyone in your home allergic to dogs?*

Yes
No

Please explain why you will still be able to adopt*

Is everyone in agreement with the decision to adopt a dog?*

Yes
No

Please explain why you will still be able to adopt*

What type of home do you live in?*

Do you...?*

Own
Rent

Please provide the rules governing pets*

Please list landlord information*

Name	Phone Number

By providing this information you are allowing Always & Furever to contact your landlord. Please inform them of this so they will speak with us)

Please describe your household:*

Active
Noisy
Quiet
Average

Do you have have time to provide adequate love and attention?*

Yes
No

You should really re-think adoption

Other Pets

Do you currently have pets?*

Yes
No

List your pets*

Type of pet (dog, cat...)	How many?

Are they up-to-date on vaccines?*

Yes
No

Explain why they are not up-to-date on vaccines*

Are they spayed/neutered?

Yes
No

Explain why they are not spayed/neutered:*

Have you ever surrendered a pet?*

Yes
No

Explain why you had to surrender the pet*

Have you ever had a pet euthanized?*

Yes
No

Explain why you had to have the pet euthanized:*

Have you ever lost a pet to an accident?*

Yes
No

How do you discipline your pets and why?*

Veterinarian

Vet's Name	Clinic Name	Clinic Address	Clinic Phone

Providing Always & Furever with this information you are allowing Always & Furever to call your vet. Please call your vet and ask them to authorize the release of information to Always & Furever.

About the Dog You Wish to Adopt

What is your idea of an ideal dog and why?*

Desired Sex*

Desired Age

Desired Size

Desired Breed

List all breeds you would you not adopt:

Check those you are willing to adopt:

Select All
Outgoing dog
Shy dog
Dog that needs regular medication
Dog that needs training
Dog that needs grooming
None of these

Where will the dog spend the day?*

Where will the dog spend the night?*

Number of hours (average) the 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

You should really re-think adoption

Do you agree to keep the dog as an indoor dog?*

Yes
No

You should really re-think adoption

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

fenced yard?, on a leash?...

Do you agree to contact Always & Furever if you can no longer keep this dog?*

Yes
No

You should really re-think adoption

Are you willing to let a representative of Always & Furever visit your home by appointment, or send photos of your residence?*

Yes
No

Are you willing to let a representative of Always & Furever contact you for updates on the adoption and post pictures online and/or via social media?*

Yes
No

How did you hear about Always & Furever? (If event, please list!)

Personal References*

Name	Address	Phone	Relationship (relative, neighbor, friend, etc.)

Please list at least 2, one family member and one non-family member. Click the "+" sign at the end of the row to add references.

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.

WE RESERVE THE RIGHT TO REFUSE ADOPTION TO ANY APPLICANT FOR ANY REASON. THIS QUESTIONNAIRE BECOMES PART OF OUR CONTRACT.

Please read carefully, check each box, and sign to indicate agreement.*

Select All
I understand that a home visit is required prior to final placement
I understand that a home visit does not guarantee placement
I agree to provide my own collar, leash and a personal ID tag at the time of completing the adoption contract.

Signature*

Name

Date