Form

Application for Dog Adoption
IF APPLICATION IS NOT 100% COMPLETELY FILLED OUT THEN THE APPLICATION WILL BE DENIED!!
Date *
Desired Dog Information
Name of Dog Desired (if applicable)
Type of Dog Desired *
Color(s)
Age of Dog Desired *
Oldest Dog Considered
Approx. Weight as an Adult Dog
Applicant Information
Name *
Address *
City *
State *
Zip *
Telephone - Home
Telephone - Cell *
Telephone - Work
Date of Birth *
Email Address *
Present Work Conditions *

Employed Unemployed Student Retired
Employer
Name of ALL adults (besides applicant) 21 years and older residing in the home, include spouses, relatives, roommates, partners, etc. *
Please provide ages of all people residing in the home including children. *
Do you or any of your family members have pet allergies? *
Co-Applicant Information
Name
Relationship
Telephone - Home
Telephone - Cell
Telephone - Work
Date of Birth
Email Address
Present Work Conditions

Employed Unemployed Student Retired
Employer
General Information
Type of Residence: *

House Apartment Condo Mobile Home Farm/Barn
If rental, are Dogs allowed:

Yes No
Complex name/address
Manager/Landlord
Manager Phone #
Fenced in yard? *
Current housing location:

City Limits Outside City Limits
Type of Street:

Very busy road Slight traffic Residential area Country road
What is the speed limit
Where will Dog live? *

Inside only Outside only Mostly inside Mostly outside
Where will Dog spend nights? *

Inside Outside
Will you allow the Dog to run loose? *

Yes No
If Yes, where?
How many hours a day will Dog be left alone? *
Where will the Dog stay when left alone? *
Describe the activity level in your home

Busy (Visits by friends, meetings, children and parties at home) Noisy (TV, stereo, machinery, tools, children playing, dogs barking) Moderate (Normal comings and goings) Quiet (Homebodies, few guests) Other (Specify)
In the absense of the primary caregiver, who will care for the dog? *
Under what circumstances would you give up this dog?
Have you researched the specific breed you are interested in?
Are you willing to take responsibility if this Dog acquires an illness or tests positive for heartworm? *

Yes No
Are you willing and able to pay the veterinary costs of caring for this dog? *

Yes No
Are you willing to take the time to work with this Dog on housebreaking or chewing, if such problems arise? *

Yes No
How much time are you prepared to allow for this Dog to adjust to your home?
Pet Information
Have you had pets in the last five years? If yes, complete the following chart *

Yes No
Name of Pet #1 Type of Pet
Years owned
Spayed / Neutered

Yes No
Inside / Outside

Inside Outside
Where is Pet now?
Name of Pet #2; Type of Pet
Years owned
Spayed / Neutered

Yes No
Inside / Outside

Yes No
Where is Pet now?
Name of Pet #3; Type of Pet
Years owned
Spayed / Neutered

Yes No
Inside / Outside

Inside Outside
Where is Pet now?
Name of Pet #4; Type of Pet
Years owned
Spayed / Neutered

Yes No
Where is Pet now?
Name of Pet #5; Type of Pet
Years owned
Spayed / Neutered

Yes No
Inside / Outside

Inside Outside
Where is Pet now?
Current or past Veterinarian / clinic
Veterinarian Telephone
Do you consider your Dog a part of the family?

Yes No
Are you aware that a dog is a large and lifelong commitment?

Yes No
How did you hear about the AAL?
Would you like to become a Volunteer?

Yes No
Personal References
Name *
Relationship *
Phone *
Best time to contact
Comments
Should be Empty:

Application for Dog Adoption

IF APPLICATION IS NOT 100% COMPLETELY FILLED OUT THEN THE APPLICATION WILL BE DENIED!!

Desired Dog Information

Applicant Information

Co-Applicant Information

General Information

Pet Information

Personal References