Adoption Application Form Applicant's Name(s)Street AddressCityZIPStatePhone NumberEmail AddressName of Dog or Dogs You Are Interested InI would consider adopting a dog with the following characteristics (check all that apply):MaleFemaleSmall (5-20 lbs)Medium (20-50 lbs)Large (50-100 lbs)Special Needs (blind, deaf, etc.)Medical ConditionBonded PairWhy are you interested in adopting a senior dog at this time?What type of personality and activity level would you prefer a new dog to have?Name of Vet, and their phone numberResidenceSingle-family homeTownhouse or CondoApartmentOwnershipOwnRentLive with relative / friendType of yardFencedUnfencedNo yardNumber of children in the home aged 0-10Number of children in the home aged 11-18Number of adults in the homeIs anyone in the home allergic to pets?NoYesOther pets in the home: list names, ages, and breedsWho will be primarily responsible for the care of this dog?On average, how many hours a day will the dog be left alone?When you are NOT home, where will the dog stay?Fenced yardCrate in the houseLoose in the houseGarageOn a tie outsideIn one room in the houseOtherWhen you ARE at home, where will the dog usually be?Fenced yardCrate in the houseLoose in the houseGarageOn a tie outsideIn one room in the houseWith meOtherWhere will the dog sleep at night?Fenced yardCrate in the houseLoose in the houseGarageOn a tie outsideIn one room in the houseWith meOtherWhat sort of daily exercise will your dog receive?What circumstances might make you decide to not keep a new dog?New jobNew babyChewing / scratchingPotty training difficultiesConflict with other petsIllnessAllergiesAggressionExcessive barkingMoving to new placeFinancial issuesOtherHow much would you estimate the annual expenses would be for this dog (food, vet, toys, etc.)?Will you maintain shots and yearly exams for the dog?YesNoHow will the dog be taken care of if you are not in town?Have you ever surrendered an animal to a shelter, pound, or rescue?YesNoIf yes, please explain:Have you ever rehomed an animal to another person before?YesNoIf yes, please explain:Would you accept an animal with a treatable medical condition?YesNoDependsHave you read the accompanying Adoption Letter, which describes the criteria and process used by Shep's Place to make adoption decisions?YesNoAny other comments or concerns?NameSubmit
