Puppy or dog you are interested in  

Full Name		Evening Phone
Address		Day Phone
City		Zip
Email Address
Occupation		Adoption Requirements Puppies Adoptions require an on-site assessment of your home. Adopter must also agree to another assessment six months after adoption. Annual vet visit mandatory, as is necessary veterinary care. All family members must abide by state & local laws & ordinances relating to the dog including leash laws, without exception. Fenced yard: fence must be tall enough and fully able to contain the puppy, even when it has reached its adult size. Puppy must be given ample exercise daily. Puppy training classes are mandatory. Adoption Fee: $300 (includes a $50 refundable deposit after completion of puppy classes) Adoption fee includes spay/neuter; micro-chipping, deworming, and first vaccines. Pound Puppy Rescue reserves the right to deny adoption based on our criteria and sound judgement. Please be aware that we cannot respond to every application, even though we would very much like to. Also, we will accept multiple applications for varying pets. If you do not hear from us, regarding one pet, then you are welcome to apply again for another. It is best to start the process all over again, so that we are made fully aware of your interest. However, if you email us to let us know that you have already applied, and give your name and address as well as the name of the puppy you're interested in, we will pull your application from our records, should it still remain on file. We do, at points, clear the application files to limit our ever increasing work load. Thank you for your understanding.
Personal Reference must include address & phone
Household Members must include names & ages also include yourself	If you do not enter your household information here (names and ages - including yourself), we will not consider the application. Also, please be aware that we do not adopt medium, large, or very active dogs to families with children who are under 6 years of age. A puppy's normal behavior is to jump and bite. Young children do not tolerate this behavior well, and the unfortunate reality is the majority of puppies end up being surrendered. Our primary intent and obligation is to select the best possible environment and home for the dog. We hope you will understand.
Living space	House Apartment Townhouse Mobile Home Other           Do you   Rent Own
If other, describe
Previous Address
Have a fenced yard?	Yes No      dog run?   Yes No
Other pets	Yes No
List other pets	List and describe your current pets here. And, note for each, if they are spayed or neutered, male/female, indoor/outdoor and their age.
Previous pets	Please list here, any pets you have had in the past 10 years. And, explain what happened to them.
Why do you want a puppy?
Where will puppy stay when alone?
Number of hours puppy will spend alone each day?
Where will puppy sleep?
How do you plan to exercise your dog?
Your Veterinarian
Vet's Phone
If you were no longer able to care for this pet, what would you do?
Comments	Please note any important particulars about your potential adoption situation and preferences for the kind dog you want to adopt: breed, male or female, age range, hair type, activity level, size or other specifics.

 
Do you agree to the following:

Allow a home inspection prior to adoption   Yes No

All members of your household want to adopt a dog   Yes No

Keep license and ID tags on dog at all times   Yes No

Provide adequate and timely health care for the dog   Yes No

Follow all federal, state & local laws regarding your dog   Yes No

I certify the above to be true and complete to the best of my knowledge:
Initials             Date