ACAS - Dog Adoption Application

Animal you are interested in adopting
Applicant's First Name *
Applicant's Last Name *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you.
Street Address *
Apartment Number (if applicable)
City *
State *
Zip Code *
How long have you lived at this address?
Do you own or rent your home? *	Own Rent
If you rent, does your landlord and lease allow pets?	Yes No Unsure N/A
Including yourself, how many people live in your household? *
Please list the ages & relationship of those who live in your home.
Does anyone in your household have allergies to dogs/cats?	Yes No Possibly N/A
Please describe in detail the pet you are looking for.
Please check the main reason you plan to adopt a pet: *	Companion Family Pet Child's Pet Guard Dog Companion for another pet Other
Do you own other pets at the current time? *	Yes No
If you have pets, will they adjust to a new pet in the house?	Yes No Unsure N/A
If yes, please list their names, breeds, ages, and how long you have had them.
How many pets have you owned in the last 5-10 years?
What happened to them?
Are all of your pets spayed/neutered/fixed? *	Yes No N/A
Are your pets current on their vaccinations? *	Yes No Not sure N/A
Have you ever turned your dog or cat into a shelter? *
If yes, please explain?
Have you ever had a pet euthanized?
If yes, please explain:
Veterinarian's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Phone Number
How many hours a day will the dog be left alone? *
How will the dog spend their alone time? * Please check all that apply.	Free roam inside Kenneled or crate trained inside Outside free roaming within a fenced area Outside in a kennel or pen Outside on a tie out Dog day care or boarding facility
Will this pet be predominantly living inside, outside, or both? *	Inside Outside Both
What type of yard security do you have? *	Chain Link Privacy Electric Tie Out No Fence
Will the dog be tied up outside? *	Yes No
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations?	Yes No
If no, please explain:
What arrangements will you make for the care of your pets in case of an emergency?	Leave with family/friend Boarding Pet Sitter Take with me/us Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?	Leave with family/friend Boarding Pet sitter Take with me/us Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning or giving up the animal?
What would you do with your animal if you had to move? *	Take him / her with me Give to family or friend Return to shelter Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
If no, please explain:
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal.	Yes No
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