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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
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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
First Pet Choice:
Adoption Fees - Purebreds/small breeds - fees may be higher.
Puppies up to 1 year: $550-$650.
Dogs 2-5 years: $350-$500.
Dogs 6 yrs.+: DISCOUNTED RATES
Please indicate what size dog you are looking for or prefer (when fully grown):
*
Small (1-25 lbs)
Medium (26-60 lbs)
Large (61-100 lbs)
Extra Large (101 lbs. or more)
It's not important.
Do you currently have other pets at home?
*
Yes
No
If you answered yes, please indicate which pets live with you:
Young Dog(s) up to 1 year
Dog(s) 1-5 years old
Dog(s) 6 years or older
Cat(s)
Other
How did you find the pet you are interested in?
*
Donna's Pet Depot
Adoptapet.com
Petfinder.com
Rescueme.org
Facebook
Petsmart
Other
What is your primary reason for wanting a new pet? Check all that apply:
*
Companion for me
Companion for children
Companion for other pet
Watch Dog
Gift
Rescue a Homeless Pet
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)?
Yes
No
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.
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