Canine Angels

Adoption Application

P.O. Box 495 La Porte, IN 46352
(219) 325-8610
CanineAngelsInc@yahoo.com

All fields are required

Full Name:		Email Address 1:
Street Address:		Email Address 2:
City/State/Zip:		Website:
Home Phone:		Cell Phone:
Work Phone:		Fax Phone:
Driver's License No.	:	Driver's License State of Issue:

Please fill out this form honestly. No answer is right or wrong. This form merely helps us to determine whether the pet you are interested in would be compatible with you and/or your family. Canine Angels, Inc. reserves the right to require a one business day waiting period before the adoption may be completed in order to contact your Veterinarian and/or landlord.

Name of the pet(s) you are interested in:

What attracted you to this particular pet(s):

Are you familiar with the breed(s) that we believe this pet to be? Yes No

If yes, how?

Are you willing to spend the time and share the space to properly care for this animal during it's lifetime? Yes No

Rescue animals have sometimes been in neglectful and/or abusive situations and; therefore, may experience difficulty
making the transition to a new forever home. Are you willing to be patient while the animal adjusts to it's new home? Yes No

What is your current living arrangement?
House Apartment Duplex Mobile Home Condo Other:

How long have you lived at this address?

Do you own or rent? Own Rent If you rent, does your lease allow pets? Yes No

If applicable, please provide: Landlord Name Phone Number

Please list the following information for all persons living in your household (including self):

Name Age Occupation Interests Work Schedule

Who will be the primary care taker of the pet?

How many hours per day, on average, will the animal be left alone?

Will the animal be kept: Inside Outside

Where will the animal be kept during the day (be specific)?

Where will the animal be kept when you are at home (be specific)?

How will the animal be taken care of when you are out of town (be specific)?

Do you have a fenced yard? Yes No Type of Fence: Fence Heigth:

If you do not have a fence, how will the animal be exercised & allowed to relieve itself?

Is this your first experience as a pet owner? Yes No

Do you own any pets at the present time? Yes No

If yes, please provide the following information:

Name	Breed/Species	Age	Up to Date on Shots?	Spayed/Neutered?	Heartworm Preventative & Type?
			Yes No	Yes No	Yes No Type:
			Yes No	Yes No	Yes No Type:
			Yes No	Yes No	Yes No Type:
			Yes No	Yes No	Yes No Type:
			Yes No	Yes No	Yes No Type:

Please provide your veterinarian's contact information who cares for your pets:

Veterinarian & Clinic Name1 Phone Number
Veterinarian & Clinic Name2 Phone Number

Routine veterinary care for your pet can be very costly. What preventative veterinary care are you willing & able to
provide for this animal?

What do you expect the annual cost of caring and providing for your pet to be on average (i.e. food, toys, grooming, vet care, etc.)?

If you move, what will become of your pet?

If you are no longer able to care for or keep your pet for any reason, what will you do with your pet?

We at Canine Angels have observed this pet and have provided you with all of the information we know to be true about this animal.
However, it may take several days or even weeks for this pet to fully adjust to its new environment.
Does this present a problem for you? Yes No

If yes, why?

Please list the names and phone numbers for three references. Please list at least two non-family members:

Name Relationship Phone

Why do you feel you would provide a good home for a rescue animal?

Please take a moment to add your comments. This information may help us to make a determination about your approval/denial:

By SUBMITTING this form, I agree that if the reference from my veterinarian is not favorable or if my landlord states that I am
not allowed to own a pet, I will consider my adoption contract null and void and I will return the adopted pet to Canine Angels, Inc.
immediately. Yes No