Dog Adoption Application

Dog Application

Want to adopt a dog? Please fill out form and click Submit.
If you want to reset the form and start over, click Reset.

Application To Be Completed By Adult Head of Household/Parent(s) Only
Dog's Name:	Date:

ABOUT YOU
Your Name:
Phone Numbers: Home: Work:
Your E-mail:			Are you over 18 years of age and head of household? Yes No
Address:
City/State/Zip:
What kind of dog are you looking for?
What are your reasons for adopting a dog?
Who is the dog for?
Who will be primarily responsible for the dog's care?
Is it a gift? Yes No Do you have children? Yes No
Do they live with you? Yes No Have they been around dogs before? Yes No
Please list their ages:
Have you ever owned a dog before? If so, what happened to it?
Do you currently have pets? Yes No		If so, please specify breed, age, and sex:
Are they sterilized and licensed? Yes No
HOME INFORMATION
Type of dwelling? House Condo Apt		Rent Own Pets Allowed? Yes No
Years at residence: Are you looking for a dog to remain: Indoors Outdoors
How many hours will the dog be left alone?
Where will the dog be kept during this time?
Do you have a fenced yard? Yes No How high is it? What type?
What type of outdoor shelter is currently available?
Where will the dog sleep?
Are you aware that you will be paying an adoption fee for this dog? Yes No
In 2005, dog owners spent an average of up to $785 on veterinarian bills. Are you willing to provide routine medical care and adequate veterinary treatment should your dog become sick or injured? Yes No
Please provide the name and phone number of your veterinarian:
Do you object to New Beginnings doing a home check prior to adoption of the dog or following placement in its new home? Yes No
How did you hear about New Beginnings for Animals?

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