Adoption Application Welcome to the first step in adopting your new friend! Please enable JavaScript in your browser to complete this form. - Step 1 of 6Identification and Contact InformationName *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMobile or Primary Phone *Other PhoneDrivers License *D/L Issuing State *D/L Expiration Date *Email and Social MediaEmail *EmailConfirm EmailFacebook PageOther Social MediaPersonal ReferencesReference-1 *FirstLastReference-1 Phone *Reference-2 *FirstLastPhone 2 *NextVeterinarian InformationCurrent Veterinarian Name *FirstLastVeterinarian Practice NamePhone Number *Fax NumberDoes this vet have your current and previous pet's vaccine and heart worm status on file? *YesNoWhere may we obtain this information? *Emergency Veterinarian Facility *Is this a 24 hour facility? *YesNoCan a vet be called in during an emergency? *YesNoHow will you pay for emergency vet care? *NextPreferences and Reasons to AdoptIf you have researched the breed, where did you find your information? Do you have additional questions or concerns? *Have you ever had a Dalmatian as a pet? *YesNoWhy do you want to adopt a Dalmatian? *Are you aware that Dalmatians require a lot of exercise and stimulation? *YesNoHow do you plan to provide the stimulation and exercise required by a Dalmatian? *What age are you interested? *Any AgePuppyYoung Adult (2-5)Over 5SeniorDoes it matter to you if your pet comes house-trained? *YesNoHow will you house-train your pet if he/she is not already house-trained? *NextResidence InformationPlease check what best describes your home. *HouseTownhouseDuplexMobile HomeCondominiumApartmentDo you rent or own your home? *RentOwnDo you have a lease contract? *YesNoWhat is the length of your lease? *What is the name of your Landlord? *Landlord Phone *Landlord Fax NumberDo you have landlord approval for pets? *YesNoList any weight limitations for pets or none *List any breed restrictions or none. *List any insurance restrictions or none. *Are you required to make a pet security deposit? *YesNoHow long have you lived at this residence? *NextLiving EnvironmentIs the property fenced? *YesNoWhat is the type of fencing? *What is the height of the fencing? *Which areas of the property are fenced? *NextDoes the property adjoin a lake, canal, pond, or other open water? *YesNoHow will you protect your pet from these water hazards? *Is there a pool on the property? *YesNois the pool fenced? *YesNoWhat precautions will you take to ensure your pet's safety around the pool? *How many adults reside in your home? *How many children live in the home?What are the ages of the children living in the home? *Is there anyone living in the home allergic to dogs? *YesNoHow will the allergies be addressed? *Is anyone home during the day? *YesNoWho will be home during the day? *If there is no one home during the day, where will the pet stay? *Signature *Clear SignatureCaptcha * = EmailSubmit Share this:FacebookXLike this:Like Loading...