Puppy/Dog Adoption Application

PLEASE NOTE - - YOU MUST BE HEAD OF HOUSEHOLD TO ADOPT FROM US

PLEASE FILL OUT THE ENTIRE APPLICATION - FAILURE TO ANSWER ALL QUESTIONS CAN RESULT IN YOUR APPLICATION BEING DELAYED. THANK YOU!

PERSONAL INFORMATION

Date *

Name *

Date of Birth: (MM-DD-YYYY) * +

Home Phone

Cell Phone *

Email Address *

Current Address *

City *

State *

Zip/Postal Code *

Are you Head of Household? *

Yes

No

Are you a student and/or do you live with roommates? *

Yes

No

REQUESTED AND CURRENT PET INFORMATION

PET OF CHOICE

Our Adoption Fees:

- Puppies to 1 year $475-$550

- Dogs 1-5 years $350-$500

- Dogs 6 years + DISCOUNTED RATES

*Purebreds/small breeds - fees may be higher.

First Pet Choice:

Please indicate what size dog you are looking for or prefer (when fully grown): *

Do you currently have other pets at home? *

Yes

No

If you answered yes, please indicate which pets live with you:

How did you find the pet you are interested in? *

What is your primary reason for wanting a new pet? Check all that apply: *

When are you ready to adopt? *

I am ready to adopt now.

Within 2-3 weeks

I would like to be preapproved for the future.

Are you interested in our ADOPT AT HOME option? NJ residents only. See our website Adoption Process for more info. Adopt at Home

Yes

No

Do you currently have an application pending approval for another puppy/dog (not with us)?

No

Yes

Are you interested in FOSTER to ADOPT? This option is not for puppies.

Yes

No

Are you interested in adopting a dog/puppy only because your children want one?

Yes

No

How many members (people) are under the age of 18 yrs. in your household?

Please state their ages:

PET HISTORY

Item 1. Is this your first pet (not a family pet that you grew up with) or has your last pet been deceased longer than 10 years?

Yes

No

Item 2. If you answered Yes, please provide 2 references. One may be a family member. You can skip to Home Environment section.

Name:

Relationship to You:

Phone Number - we text only.

Name:

Relationship to You:

Phone Number - we text only.

Young Dog(s) up to 1 year	Dog(s) 1-5 years old	Dog(s) 6 years or older
Cat(s)	Other

Companion for me	Companion for children	Companion for other pet
Watch Dog	Gift	Rescue a Homeless Pet