Fill and Sign the Ad904 a Form

Adoption Application Welcome! In order for us to help place a pet with you that is best suited to you, and most compatible with your home, please take a moment to fill out this adoption application. Your Name _______________________________________________________________________ Your Address _______________________________________________________________________ City State Home Phone Zip Code Work or Cell Phone E-Mail How many adults in the home ? How many children in the home Please list their ages: How many pets do you currently own: Dogs: ______ Cats: ______ Other Your pets: breed, gender, age, and disposition with other animals: Spayed or Neutered ? Spayed or Neutered ? Spayed or Neutered ? How did you obtain these pets Please list the name and phone # of your veterinarian(s): Do you own or rent your home ? • • Landlord’s name Landlord’s phone Do you have a fenced yard? Yes No If yes, what kind? I would like a dog that is (please circle all your preferences): • • Young (puppy – 2 yrs) Very Active • Good with cats • Already Spayed / Neutered Middle age (3 – 5 years) Older (6 and older) Somewhat Active Pretty Mellow Good with dogs Good with kids Doesn’t matter I will spay / neuter within 3 months How do you plan to exercise a new dog? Walk on leash Play in yard Kennel/run Other_____________________ How many hours a day will your new pet spend alone ? Do you intend to keep your pet inside ? If not, where Where will your new pet stay when you are not home ? Have you ever used a training crate with a puppy or a dog? Yes No Have you ever taken a puppy or dog to training classes? No Yes What circumstance or problem would cause you to “give up or return” your new pet ? Would you be willing to let one of our representative or volunteers visit your home ? Yes No Please provide the name and addresses of 2 people (not relatives) who have personal knowledge of your experience with animals. Personal Reference # 1 Address Phone (home or cell or both ) How does this person know you ? Personal Reference # 2 Address Phone (home or cell or both ) How does this person know you ? I certify the information I have given is true, and I realize that any misrepresentation of facts may result in my losing the privilege of adoption a pet. I understand you have the right to deny my request to adopt an animal for any situation or not in the best interest of the animal. I authorize investigation of all statements in this application, and also authorize my vet to release any information requested by you . Signature Please return form to: Date DogGone Adoptions P.O. Box 161 Piqua, OH 45356-0161