Manchester Animal Control Adoption Application
420 Magnolia Street

Manchester, GA  31816

Phone #:  706-846-9022  Email Volunteer:  chiefbrody@alltel.net

Adopter's Name Driver's License #

Address


Home Phone                     Cell Phone 

Email Address 

Occupation and Place of Employment

Work Phone 

Dog Information

Dog's ID Number                 Name of Dog You Wish to Adopt 

Have you had this breed before? YesNo

What do you know about this breed? 

List its good traits.

List its bad traits.

Do You Have Children at Home? YesNo
Please give children's names, sexes, ages.


How many adults in home?  Does everyone work? YesNo

What hours do people work outside of the home?

What is the longest period the dog will be left alone? 

Where will the dog be left while left alone? 

Where will the dog sleep? 

Do you live in a house/apartment/condo/etc...? 

Do you have a fenced yard?  YesNo

How tall is the fence? 

Do you own or lease? 

(If lease) Does your lease allow pets?  YesNo
Landlord's name/address/telephone:

If you lease we must have a written approval from your landlord allowing a dog up to 20 lbs.  Please email the written approval to the MAC volunteer immediately.  Email to chiefbrody@alltel.net.

Will you keep your dog in the house?  YesNo

What temperament and other qualities are you looking for in a dog?

Please list all your Current Pets (dogs, cats, birds, etc.) List breeds and if they are altered.

Please list all your Previous Pets (dogs, cats, birds, etc. ) List breeds and if they were altered.

What happened to the previous pets?

Do you have a veterinarian you use now?  YesNo

                                      Veterinarian Information

Address

Phone Number 

Personal References & Phone Numbers (no relatives, please)

1)Name Phone #
2)Name Phone #
3)Name Phone #

Are you financially prepared and able to provide routine medical care and upkeep for a dog at this time?  YesNo

I give my permission to contact the references I have given. Yes  No (Note:  In order to be considered for adoption purposes, you must be willing to have references checked, along with previous and current veterinarian information.)

Please check yes or no for the following statements.

I understand that Manchester Animal Control is not responsible for the health status of dogs adopted from this facility. YesNo

I understand that Manchester Animal Control is not responsible for the adopted dog once the dog is in the custody of the adopter.YesNo

I understand I must have my adopted dog vaccinated for rabies and spayed/neutered within one month of adoption.  YesNo

A rabies certificate and spay/neuter certificate must be provided to the animal control officer or volunteer within one month of adoption.  We do not have the dog vetted before adoption unless previously arranged by the adopter.  By typing in your full name below, you are agreeing with all statements above and swearing that the personal information provided is accurate.

Full Name             Date