Dog Adoption Application

Dog’s name *	Alana (Cat - S2024095) Benson (Cat - S2024117) Ebony (Cat - C2024110) Fudge Round (Cat - C2024057) Moonpie (Cat - C2024179) Nessa (Cat - C2024178) Raven (Cat - S2024047) Robin (Cat - S2024050) Skips (Cat - S2024115) Star Crunch (Cat - C2024058) Swiss Roll (Cat - C2024056) Wren (Cat - S2024048)
First Name *
Middle Name *
Last Name *
Date of birth *
Street Address *
Apartment number
City *
State *
Zip code *
Email address *
Telephone *
Work telephone	NoYes
Driver’s License State *
Driver’s License number *
Driver’s License Expiration Date *
Employer and position *
Employer’s address
Length of employment
How long have you lived at your address *
What’s your living status? *	Rent by yourself Rent with a roommate live with family Own
If renting, does landlord allow pets?
Landlord’s Name and Phone # *
Type of housing where you live *	Single Family House Apartment Duplex Condo townhouse Mobile Home Cabin RV
Are you willing to have a home check? *	NoYes
Do all residents in the home know about and want the dog? *	NoYes
If not, explain:
Do any family members have a dog allergy? *	NoYes
How many hours will the dog be alone? *
Lifestyle in the home *	Quiet/Relaxed Active Lots of kids in and out Lots of Noise/Very Loud Travel Often
How many kids are in the home? *
What are the ages of the kids that will be in the home?
Why do you want to adopt this dog? *	My pet Family pet Child’s Pet Guard Dog for a Business Watch Dog Companion for another pet Gift
Do you have a fenced in yard? *	NoYes
If yes, does it have a shelter in it?	NoYes
Where will this dog live regularly? *	Indoor Only Outdoors Only Indoor and Outdoors
If both outdoor and indoor then how long will the dog be outside?
How will you keep the dog confined to your property? *	Inside in the Basement In the Garage Inside in a Crate Inside free run of the house Inside In 1 room Outside in a fenced yard Outside on a chain or runner Wireless Fence
Are you willing to work with the dog if not fully potty trained? *	NoYes
Have you ever crate trained a dog? *	NoYes
Will you keep a collar with updated information on the dog at all times? *	NoYes
Will you get the dog microchipped and keep the information updated? *	NoYes
Do you plan to use flea and tick prevention? *	NoYes
Do you know what Heartworms are and plan to use Heartworm prevention? *	NoYes
Do you have a plan if you are no longer able to take care of your dog? *	NoYes
Who will take care of the dog while you are on vacation? *
If you move, will you take your dog with you? *	NoYes
Are you prepared to commit to take care of this dog for its entire life which could be 10-15 years? *	NoYes
Have you ever surrendered a pet to an Animal Control/Humane Society/Rescue before? *	NoYes
If yes, explain the circumstances
Have you ever give a pet away because things didn’t work out? *	NoYes
If yes explain circumstances
Do you agree to return the dog to NGAA if you need to rehome him/her? *	NoYes
How many animals are currently in the home? *
List all the pets in the home, breed, sex and if altered *
List all the pets you have had in the last 10 years and why you no longer have them *
Do you have a veterinarian? *	NoYes
If yes list name and address
List the names, phone numbers and addresses of 2 references that don’t live with you *
Signature *	Clear
Date *