Dog Adoption Application

Personal Information

Name*

Date of Birth Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909

Spouse or co-applicant

Street Address

City/State/Zip Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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

What area of Memphis do you live in?   East Memphis Downtown Midtown Other I do not live in the Memphis area

Home Phone Number

Work Phone Number

Cell Phone Number

Email Address

Occupation

Spouse/co_applicant Occupation

Are you a student? Yes  No

Name of pet you are appling for

Home Information

Please describe your home environment?   Apartment House Condo Townhouse Trailer Mobile Home

Do You Own or Rent? Own  Rent

If you rent, do you have the landlord's permission to adopt an animal? Yes  No

Name of Landlord and phone number:   

Is there is a pet deposit or fee required? Yes  No

If so, have you paid it? Yes  No

Do You Have a Pool? Yes  No

Do You Have a Pet Door? Yes  No

Do you have a COMPLETELY Fenced In Yard? Yes  No

If Yes, How Tall Is The Fence?

What type of fence do you have?

If you do not have a fence, how do you plan to confine the pet to your yard?

Family/Pet Information

Number of adults in your household?

Do any children live in or visit your home? Yes  No

If so, What are their ages?

Please list the names, ages, and breeds of the pets you currently own

Have your pets been spayed or neutered? Yes  No

If no, please explain

Are your pets vaccinated? Yes  No

Are your pets on heartworm prevention? Yes  No

If so, what brand?

How many times a day and what brand food do you feed?

Please list the pets you have had in the past and explain what happened to them

Does your job require that you move or travel often? Yes  No

When traveling what do you do with your pet?

Vet Information

Who is or was your Vet?

Vet's Phone Number

Pet Care Information

Please describe what a typical day and a typical week will be for your new pet

Where will the dog spend its days and nights?

How many times a day and what brand food will you feed your new pet?

How many hours a day will the pet be left alone?

Do you plan to allow the dog outdoors? Yes  No

How long do you plan to keep this pet?

What behaviors would you consider unacceptable in your pet?

How would you discipline your dog from unwanted behavior?

How would you correct these behaviors?

What would you do if your dog kept having accidents in the house?

Have you ever kennel trained a dog before? Yes  No

Are you prepared for the costs involved in properly caring for a pet (food, treats, toys, grooming, shots, heartworm, flea and tick prevention, litter, etc.)? Yes  No

Many breeds are now banned in apartments and by insurance companies. If you are applying for a rottweiler, german shepherd, akita, doberman, pitbull, chow, or other guardian type breed, have you checked with your homeowner's insurance to make sure that you are allowed to own the breed? Yes  No

If you are applying to adopt a rottweiler from us, what insurance company are you with?

Is the animal going to be a gift for someone? Yes  No

Are other members of your family aware that you want to adopt an animal? Yes  No

Is anyone in your family allergic to animals? Yes  No

Do you have any health issues that could affect your ability to care for a companion pet? Yes  No

Have you adopted an animal before? Yes  No

If so, where?

General Information

How did you hear about us? Facebook
Petfinder
Friend
Other

Do you understand that if you adopt a pet from us, you are required to return the pet to us if you can no longer keep it? Yes  No

The vet reference is usually all we need as a reference, however in some cases we do need to check other references. Please list 2 references, including name and telephone number in case we need to contact them.

We very rarely adopt long distance, if you are out of our area, how would you plan to get the pet?

How would you return the pet to us if the pet didn't work out in your home?

Please add any comments you would like to make here that will help us make a good decision for you and for your new companion.