The Dog P.E.N.

PO Box 2
Roodhouse, IL 62082
thedogpen.petfinder.com
themuthut@yahoo.com

Adoption Application

To be eligible to adopt a pet from The Dog P.E.N., you must be 18 years of age or older. This application has been designed to assist us in determining if you and your family are a good match for the pet that you are interested in adopting. Our foster homes care greatly for the animals under their supervision. Please understand that it is their responsibility to find permanent, loving homes for these pets. Therefore, we do have application guidelines and we reserve the right to deny any adoption we think is unsuitable.

Name of pet you are applying for:

Household Information

Name:
Drivers License:
Street Address:
City:
State:
Zip Code
Email Address:

Housing:

If renting:

Landlord Name:
Landlord Phone:
Length of time at this address:

Others living at this household (include ages of children and neighbors that might visit):
Is everyone in your household in agreement with adopting this animal? If no, please explain:

Pet History

What animals do you currently own? (If more than three, please use the 'Other' section)
Pet one

Species:
Age:
Sex:
Kept:
Altered?
How long have you had this animal:

Pet Two

Species:
Age:
Sex:
Kept:
Altered?
How long have you had this animal:

Pet Three

Species:
Age:
Sex:
Kept:
Altered?
How long have you had this animal:

Other pets:

What is your experience with small animals?

Who will be responsible for taking care of the pet?(feeding, excercise, cleaning up after the pet?

Dogs and cats often live longer than 15 years. Are you prepared to take responsibility for this pet for its entire lifetime?

Do you agree to return the pet to The Dog P.E.N. if you can no longer keep it?

In some instances, it may take a new pet up to a month to adjust to a new home. Are you willing to allow this much time for adjustment?

Your household activity level is:

I'd enjoy brushing or grooming my pet:

Prefer to have pet professionally groomed:

I need a pet that will tolerate being alone hours per day

Please complete this section if you are applying to adopt a CAT

Why are you adopting a cat? If other, please explain:

Where will your cat sleep at night?

Will your cat be allowed outside?

Are you willing to pay a deposit and agree to have the cat spayed/neutered in a designated timeframe, if it has not been done before the adoption?

Please complete this section if you are applying to adopt a DOG

Why are you adopting a dog? If other, please explain:

If your intent is to use the animal as a guard dog, how do you intend to train and socialize the animal so it is not unlawfully aggressive with humans and other animals?

Where will your dog be kept during the day? If other, please explain:

Where will your dog sleep at night?

On average, how many hours will the dog be left alone each day?

On average, how many hours will the dog be left alone each evening?

Your availability to exercise a pet: If other, explain:

Do you have a completely fenced yard?

If you do not have a fenced in yard, how will the dog relieve itself? If other, explain:

Would you enjoy taking the dog for rides in the car?

If your new dog is not already housebroken, how do you plan to housebreak him/her?

If you experience behavior problems with your dog, how do you intend to resolve them?

If necessary, are you willing to crate train?

If necessary, are you willing to enroll in obedience training courses?

Are you willing to pay a deposit and agree to have the dog spayed/neutered in a designated timeframe, if it has not been done before adoption?

References (you must provide us with at least two, unrelated individuals that are not living with you)

Name:
Phone:
How do you know this person?

Name:
Phone:
How do you know this person?

Name:
Phone:
How do you know this person?

Adoption Follow-up

As part of our commitment to having each adoption be a success, we will be keeping in touch with you. Please indicate the most appropriate time and place to reach you.

Time:
Phone:
E-mail:

By submitting this application, I hereby release to The DOG P.E.N. all veterinary records of all animals I have had or currently have.
Name of Veterinarian:
Veterinarian's Phone or Business Address:

Terms of Application Agreement

I certify that I am 18 years of age or older and that the information provided on this application is true and correct to the best of my knowledge. I also acknowledge falsification of any information on this application can result in my being denied adoption of this animal. I authorize investigation of all statements in this application and understand veterinarians, other humane agencies, landlords, etc, may be contacted. I further understand that the adoption of any animal may be delayed until information on this application can be verified.

Name of submitter:
Date: