DOG ADOPTION APPLICATION

STEP 1: YOUR INFORMATION

Are you over the age of 21? *

yes
no

You must be at least 21 years old to apply for adoption, if you are under 21, your parent or guardian must fill out the application.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How many years at this address? *

Phone *

Email Address *

Have you adopted from us before? *

yes
no

Do you live in a: *

Do you live with your significant other, parents or roommates? *

significant other
parents
roommates
neither

If renting or living with a relative, Name, Address, Phone of Landlord/Relative: *

STEP 2: ANIMAL INFORMATION

What is the animals name you are applying for? *

List the ages of all children living in your household: *

Tell us why you are applying for adoption today: *

STEP 3: HOW YOU WILL CARE FOR THE DOG

If you have been in contact with a volunteer of Pet Rescue of Mercer, what is their name? *

Where will the pet be housed? *

Do you have a fenced in yard? *

yes
no

Approx how many hours a day will this pet be left alone? *

When no one is home, what provisions will be made for this pet? *

Will you leave your pet unattended in your yard? *

yes
no

Where will this pet sleep? *

Are you familiar with crate training? Do you plan to crate train? *

Are you willing to take the time to work with a dog on housebreaking issues, should the need arise? *

yes
no

Do you understand and accept that changing a dog's environment may cause the dog to have accidents, especially in the early days of the adoption? *

yes
no

The average dog has a life span of 10 to 16 years. Are you willing to make a commitment to this dog for the rest of his/her life? *

yes
no

Do you understand and accept that changing a dog's environment may cause the dog to have accidents, especially in the early days of the adoption? *

yes
no

Are you aware of and prepared to take full responsibility for any and all medical conditions and temperament issues that this breed is prone to? *

yes
no

If a behavioral problem arises, what steps will you take to work on it? *

Are you aware of whether or not your homeowner's insurance company covers this breed of dog? *

Are you aware of and prepared to take full responsibility for any and all medical conditions and temperament issues that this breed is prone to? (copy) *

yes
no
I dont know

Are you experienced with this breed of dog? If Yes, please explain: *

If you do not have experience with this breed, have you done research to ensure that this type of dog will do well with your family's lifestyle? Please explain:

What will you do with the dog if you move or change housing? *

Please list as much information as you can about your current pets: *

(Please include Name, type, breed, age and how long they have been with you)

Please list all pets have you had in the past 5 years that are no longer with you: *

Include type, name and age

What happened to the pets that are no longer with you? *

Deceased
Given Away
Stolen
Ran Away

Choose all that apply

Are / were all the above animals spayed/neutered? *

yes
no

How much do you think you spend in medical bills on this pet a year? *

What is the name and phone number of the veterinary hospital where your animal(s) has/have received care and vaccinations: *

Please list 2 NON-FAMILY references below: *

Include full names, telephone numbers & relationship

Are all family members excited about this adoption? *

yes
no
somewhat

STEP 1: YOUR INFORMATION

STEP 2: ANIMAL INFORMATION

STEP 3: HOW YOU WILL CARE FOR THE DOG

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