Before you complete this application, please confirm that you are:
Parent or Head of Household Age 21 or Older Ready to adopt a dog NOW
 (We don't "hold" applications for future adoptions)
This Application Must Be Completed By Adult Head of Household/Parent(s) Only
Please complete all questions and fields. If not applicable, please indicate.

Date:
Dog's Name:
   
ABOUT YOU
Your Name:
Address:
City, State, Zip    
Home Phone:
Work Phone:
Email Address:
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
How many people are living in your household?
What are their ages?
If anyone under age 18 is living with you, have they been around dogs before?   Yes     No
Does anyone in the household have allergies?

If Yes, Please Explain:

   Yes     No
Have you ever owned a dog before?   Yes     No
If Yes, what happened to it?
What reasons would make you give up your dog?
Have you ever given up a dog before?   Yes     No
If Yes, please explain:
If your adopted dog develops behavior problems, how will you handle it?
Do you currently have pets?   Yes     No
If Yes, please specify breed, age, and sex:
Are they spayed / neutered?   Yes     No
Are they licensed?   Yes     No  Not applicable
HOME INFORMATION
Type of dwelling   House    Condo   Apt.
Rent or Own   Rent    Own
If you Rent, do you have Landlord's permission?   Yes    No
Years at this residence:
Do you have a yard?   Yes    No
If Yes, is it fenced?   Yes    No
If Yes, how high is the fence and what type?
Do you have a patio?   Yes    No
If Yes, is it fenced?   Yes    No
If Yes, how high is the fence and what type?
Do you have a balcony?   Yes    No
If Yes, is it fenced?   Yes    No
If Yes, how high is the fence and what type?
Do you have a jacuzzi/spa or pool?   Yes    No
If Yes, is it fenced?   Yes    No
Where will your dog spend time while you're home? Indoors  Outdoors Both

Please explain:

Where will your dog be kept when no one is home? Indoors  Outdoors Both

Please explain:

How many hours will your dog be alone each day?
What type of outdoor shelter is currently available?
Where will the dog sleep at night?
Who cares for your dog when you vacation?
Are you aware that you will be paying an adoption fee for this dog?   Yes    No
In 2008, the annual cost for basic care (food, medical, supplies, grooming/flea treatment) was $800 to $1,500 a year, not including medical treatment for emergency health issues.  Are you able and willing to pay these basic expenses PLUS any additional costs if your dog becomes sick or injured?   Yes    No  I don't know
Please explain:
Please provide the name and phone number of your current veterinarian, or the veterinarian who treated your most recent pet (if applicable): Vet's Name:   
Vet's Phone:
Do you object the New Beginnings doing a home check prior to adoption of the dog or following placement in its new home?   No    Yes
How did you hear about New Beginnings for Animals?