Adoption Application

Welcome to the first step in adopting your new friend!

- Step 1 of 6

Identification and Contact Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Mobile or Primary Phone *

Other Phone

Drivers License *

D/L Issuing State *

D/L Expiration Date *

Email and Social Media

Email *

Email

Confirm Email

Facebook Page

Other Social Media

Personal References

Reference-1 *

First

Last

Reference-1 Phone *

Reference-2 *

First

Last

Phone 2 *

Next

Veterinarian Information

Current Veterinarian Name *

First

Last

Veterinarian Practice Name

Phone Number *

Fax Number

Does this vet have your current and previous pet's vaccine and heart worm status on file? *

• Yes
• No

Where may we obtain this information? *

Emergency Veterinarian Facility *

Is this a 24 hour facility? *

• Yes
• No

Can a vet be called in during an emergency? *

• Yes
• No

How will you pay for emergency vet care? *

Next

Preferences and Reasons to Adopt

If 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? *

• Yes
• No

Why do you want to adopt a Dalmatian? *

Are you aware that Dalmatians require a lot of exercise and stimulation? *

• Yes
• No

How do you plan to provide the stimulation and exercise required by a Dalmatian? *

What age are you interested? *

• Any Age
• Puppy
• Young Adult (2-5)
• Over 5
• Senior

Does it matter to you if your pet comes house-trained? *

• Yes
• No

How will you house-train your pet if he/she is not already house-trained? *

Next

Residence Information

Please check what best describes your home. *

• House
• Townhouse
• Duplex
• Mobile Home
• Condominium
• Apartment

Do you rent or own your home? *

• Rent
• Own

Do you have a lease contract? *

• Yes
• No

What is the length of your lease? *

What is the name of your Landlord? *

Landlord Phone *

Landlord Fax Number

Do you have landlord approval for pets? *

• Yes
• No

List 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? *

• Yes
• No

How long have you lived at this residence? *

Next

Living Environment

Is the property fenced? *

• Yes
• No

What is the type of fencing? *

What is the height of the fencing? *

Which areas of the property are fenced? *

Next

Does the property adjoin a lake, canal, pond, or other open water? *

• Yes
• No

How will you protect your pet from these water hazards? *

Is there a pool on the property? *

• Yes
• No

is the pool fenced? *

• Yes
• No

What 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? *

• Yes
• No

How will the allergies be addressed? *

Is anyone home during the day? *

• Yes
• No

Who will be home during the day? *

If there is no one home during the day, where will the pet stay? *

Signature *

Clear Signature

Captcha *

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Email

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