Dog Adoption Application

YOU MUST BE HEAD OF HOUSEHOLD TO ADOPT FROM US

Date *

Our Adoption Fees: *

Puppies 5 months and younger – $400

6 months to 3 years – $350

Dogs 4-7 years - $275

Senior Pets (8 yrs.+) DISCOUNTED RATES

Are you Head of Household? *

Yes

No

Do you presently live with roommates? *

Yes

No

Please indicate your age range. *

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

Name of Requested Pet:

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

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

Name *

Address *

Town *

State *

Zip/Postal Code *

Phone Number: *

Email Address *

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

2. Please state their ages:

2. Is this your first pet (not a family pet that you grew up with) or has your last pet been deceased longer than 5 years?

Yes

No

3. If you answered Yes, please provide 2 references. One may be a family member. You can skip to Question No. 8.

Name:

Relationship to You:

Phone Number:

Name:

Relationship to You:

Phone Number:

21-30 years old	31-45 years old	46-55 years old
56-65 years old	66-75 years old	76 years and older

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