Fill and Sign the Texas Certificate Insurance Form

8806 State Route 64 Swanton, OH 43558 419-825-3622 Ph 419-825-3710 Fax info@adai.org www.adai.org ADAI PET HOME ADOPTION APPLICATION Name____________________________________________ Date_____________________________________ Address__________________________________ City___________________ State______ Zip ____________ Home Phone_______________________ Cell_______________________ Work________________________ Email_________________________________ Preferred means of contact Phone Email Persons in Household, ages:__________________________________________________________________ ____________________________________________________________________________________________ Pets in Household___________________________________________________________________________ Home: own or rent*? (Circle) If rental, do they allow dogs?____________________________________ Landlord’s Name_____________________________________ Phone________________________________ *If renting, letter printed on letterhead from landlord stating that dogs over 50lbs. are allowed on premises will need to be included with this application.* Do you have a fenced in yard? If not, how will you allow the dog to relieve itself and get exercise?___________________________________________________________________________________ ____________________________________________________________________________________________ Who will have the primary responsibility for care and training of the dog?______________________ ____________________________________________________________________________________________ Is everyone in the household supportive of having a dog in the home? ________________________ How do you plan to discipline the dog when they do something unacceptable? ______________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Have you ever owned a dog before? Please describe. ________________________________________ _____________________________________________________________________________________________ Where will the dog stay at night?_____________________________________________________________ Where will the dog stay when you are not home? ____________________________________________ Have you ever had a pet hit by a car? If yes, how will you prevent this from happening in the future? ______________________________________________________________________________________ Are you willing to wait several months to receive a “released” dog? __________________________ Do you have any concerns or questions about the possibility of adopting a “released” dog? ____________________________________________________________________________________________ Would you be willing to make a donation to help cover the costs already invested in the dog? ____________________________________________________________________________________________ Please list 3 personal references with phone numbers: 1) Name_______________________________________________ Phone______________________________ 2) Name_______________________________________________ Phone______________________________ 3) Name_______________________________________________ Phone______________________________ Veterinarian Office__________________________________________________________________________ Name________________________________________ Phone_______________________________________ ADAI highly recommends continuing the training process of our released dogs by attending basic obedience classes from a Positive Reinforcement Trainer. This will create a firm bond between you and your new companion. If you have a trainer in mind, please list the following. Organization/Company_____________________________________________________________________ Name of Trainer_____________________________________ Phone_________________________________ I, ___________________________________, certify that the information contained in this application is correct to the best of my knowledge. Signature____________________________________________________________________________ Thank you for your interest in our program. Your application will be reviewed and an ADAI representative will contact you in the near future.