K9 Orphans - Adoption Application

Are you interested in adopting more than one dog? *
Yes
No
Not sure

Dog(s) you are applying for (or enter "Not Sure") *

First Name *

Last Name *

Spouse/Partner/Roommate Name

Address *

City *

State *

Zip Code *

List your main contact number first, followed by others if you wish

Cell Phone (w/area code) *

Home Phone (w/area code)

Work Phone (w/area code)

Email *

Are you on Facebook? *
Yes
No

Marital Status *
Single
Married
Divorced
Widowed

How old are you? *

Occupation/Place of Work *

How many adults 21+ live in your home? *

List name, age, M/F, and relationship to you

How many individuals under 21 live with you? *

List name, age, M/F, and relationship to you

Who will be the main caregiver for the dog? *

How many hours a day will the dog be home alone? *

Where will the dog be kept when you are not at home? (crate, pup pen, outside kennel, loose indoor or outside) *

Please describe the dog's living situation (house pet, live in basement/garage, guard dog, live outdoors, etc.) *

How will you exercise the dog? (daily leash walks, cable or pup run in yard, free to run in fenced yard, free to roam off leash and unsupervised in unfenced area, dog park, etc) *

How will the dog be cared for during overnight absences or while on vacation? *

What is your housing situation? (own, rent, live with parents, etc.) *

If you rent, have you received the landlord's approval to have a dog?
Yes
No

If you rent, provide your landlord's name and phone number for verification.

If your landord allows dogs, is there a breed restriction?
Yes
No

If yes, please list breeds not allowed

Does your home owner's insurance allows you to own they type of dog you are applying for? (We will need proof before the adoption can be finalized) *
Yes
No
Not sure
N/A (rent)

What is the size of your yard? *
Small
Medium
Large

Is your yard fenced? *
Yes
No
Partially fenced

What type of fence?

What is the height of the fence?

Do you have other pets? *
Yes
No

If so, provide the following for each pet: name, breed, gender, age, spayed/neutered, shots up-to-date?

Are you familiar with heartworm disease and if so, how would you prevent it? *

If you had other pets in the past, please let us know their current whereabouts and provide details. (e.g. still have, died of old age/disease, hit by a car, given away, diappeared/lost, turned into shelter, etc)

List types of behavior problems you consider NOT to be acceptable. *

How would you discipline the dog? *

What will you do if the dog gets into and ruins something you value? *

Have you ever obedience trained a dog before? *
Yes
No

Are you willing to take a dog for obedience classes? *
Yes
No

If no, please explain.

Are you willing to house train a dog? *
Yes
No

Have you ever given up a pet? *
Yes
No

If yes, please explain.

What circumstances, in your opinion, justify re-homing an animal? *

What would you do if you could not keep the dog? Please be specific. *

At what point would you consider humane euthanasia, should your dog become ill? *

Have you or anyone in your home been convicted of a crime? *
Yes
No

If yes, who and what for?

Have you ever had a complaint with Animal Control? *
Yes
No

If yes, please explain.

Please supply the name and phone number of your current veterinarian, or the one who saw your previous pet(s). If the records are under a different name than yours, please list that here. *

Please call your vet and give permission for them to release information to K9 Orphans, Inc. Failure to do so can result in a delay in the processing of your application.

List at least two additional references who are not related to you and are not affiliated with K9 Orphans, and their phone numbers. *

How did you hear about K9 Orphans? *

Is there anything else you would like us to know about you?

Remember that pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, proper shelter, training, and exercise for your pet? *
Yes
No

Signature *

By typing your name you agree that all information provided on this form is correct to the best of your knowledge.

Date *

Security Code *
CAPTCHA