Adoption Application (Dog)

Please read carefully and complete this application. Thank you for considering adopting a shelter animal. Please consider the time, effort, and financial commitment to properly care for an animal (estimated $1000 or more annually for food, supplies, vaccinations, and veterinary care). Responsible pet ownership is a commitment to provide love, care, and companionship for the entire life of the pet. The adoption fee is non-refundable and due to space constraints all adoptions are final.

Animal you are interested in adopting *	Nubbins (Dog - D2512003)
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *	AR AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code *
Cell Phone Number *
Email Address * Please enter correctly as this is the main way we will contact you.
Confirm email
Date of Birth *
Drivers License Number *
Where did you see this pet? *	Facebook Website Petfinder/Adopt-A-Pet Newspaper Other
If Other, where did you see this pet? *
Do you currently own, rent, or lease the residence where you live? *
How long have you lived at your current residence? *
If you are not the property owner, we will need to verify the the pet policy at your residence.
Landlord's Name
Landlord's Phone Number
How many people live in your home and their ages? *
Who are you adopting this animal for? *
What will you do with your pet if you move in the future? *
Does anyone is your household have allergies? *
Who will be primarily responsible for the care of this pet? *
Which best describes your reasons for adopting? Check all that apply *	Companion Guard Dog/Protection Gift Obedience Training/Agility Walking/Jogging Buddy Other
If you answered "Other" above, please explain here: *
How many hours will the pet be alone each day? *
Where will the pet be kept when no one is home? *
Where will the pet be kept at night? *
Do you have a fenced yard? If so, how high is the fence? *
If you have other pets: Are their vaccinations current? *	NoYes
Why are they not current? *
Have you ever given up a pet? *	NoYes
Why did you give up pet? *
What type of pets do you own currently or in the past 5 years? Are they spayed/neutered? Current on vaccinations? Do you still have them? *
Who is/was your veterinarian? * If you currently don't have pets, please list the veterinarian you plan on using if approved.
Please provide 2 personal references and their phone numbers. *
Do you understand that dogs may live 15 years or more? *	NoYes
If your application is approved, when would you be able to bring your new pet home? *
It could take 3 weeks or more for your new pet to adjust to its new home, ESPECIALLY if other pets are involved. Are you prepared to allow the animal time to adjust? *
Attach picture of driver's license or other official ID *
You are certifying that the information you are providing is true and accurate. You recognize that an misrepresentation of the information of the application may result in your application being denied and/or losing privileges of adoption from Baxter County Animal Control in the future.
Please electronically sign. *	Clear