| This is a Canine (dog) pre-adoption application. Which canine are you interested in adoptiong? | |
| Your full name: | |
| Street Address: | |
| City | |
| State | |
| Zip Code | |
| Daytime Phone | () - |
| Evening Phone | () - |
| Cell phone: | |
| E-mail Address | |
| Your age: under 21; 21-40; 40-60; 60+ : | |
| Occupation? | |
| Employers Name: | |
| Hours per day worked? | |
| Name of spouse,companion or roomate(s): | |
| Spouse,companion or roomate(s) occupation: | |
| Spouse,companion or roomate(s) employer: | |
| Spouse,companion or roomate(s) hours worked per day? | |
| What Breed preference are you most interested in adopting? | |
| What coat length? (short, medium, long, doesn't matter) | |
| Are you looking to adopt a non-shedder, low-shedder, or shedder? | |
| When your dog reaches adulthood, what size are you looking for? (small up to 20 pounds, meduim 30-50 pounds or large 60+ pounds)? | |
| What is the reason you want a dog? | |
| Is this your first time experience with a dog? | |
| Is this pet a gift? If yes, who is the gift for? | |
| Is this pet for your family and does the entire family want a pet? | |
| Whose responsibility is the care of the pet? | |
| Are all members of your household aware you're adopting a pet? | |
| How many adults live in your household? | |
| How many children and what are their ages live in the household? | |
| Does anyone in the household have allergies and if so to what kind of animal(s): | |
| Do you own or rent your dwelling? | |
| What type of dewelling? (ie-house, apartment,condo,townhouse, mobile home, live with relatives) | |
| How long have you lived at your current address? | |
| If renting, are pets allowed? | |
| If renting, is a deposit required to have animals? | |
| If renting, is there a weight limit? | |
| If renting or living in a townhouse/condo community, please list the name of your Landlord or management company: | |
| Please list the Landlord or management company's phone number: | () - |
| If you move where pets are not allowed, what would you do with our pet? | |
| Do you have a yard? Is it fenced in? | |
| If the yard is fenced in, please specify the type and height of the fence. | |
| If you do not have a fenced in yard, how will you keep your pet at home? | |
| Where and how will you excercise your pet? | |
| How many hours will your pet be alone? | |
| Do you have any pets now? | |
| If you have pets, please list them all, including their breed, age, sex, spayed or neutered, licensed, and up to date on vaccinations: | |
| Other than above, please list any pets that you've had within the past 10 years and what happened to them. | |
| It may take your new pet a month or longer to adjust to its new home. How will you handle this? | |
| Where will your pet be kept (ie-house,garage,basement,outdoors,outdoors kennel, tie out, crate, etc) | |
| Would you consider crate training? | |
| Would you attend obedience classes? | |
| Are you prepared for chewing, digging, scratching, house training, accidents, and other mischievous behavior? | |
| How will you handle these behaviors and how will you reprimand your pet? | |
| Veterinarians Name: | |
| Veterinarians Address: | |
| Veterinarians Phone: | () - |
| What name are your pets records under: | |
| Have you applied for a pet from any other organization or shelter? | |
| If yes, when and where? | |
| Please list 3 personal references not living with or related to you. Provide name and phone number: | |
| Do you understand and agree that there is a non-refundable adoption fee for each animal? | |
| Will you allow a S.T.A.R.T. representative to visit your home? | |
| Will you agree to contact S.T.A.R.T. if you can no longer keep this dog? | |
| Do you certify that the information collected above is complete and correct to the best of your knowledge and that START reserves the right to contact persons listed above? | |
| Thank you for completing this form. After its review, a volunteer will contact you. If you have any additional comments, let us know here: | |
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