KPFL Dog Adoption Form

Kootenai Pets for Life
Dog Adoption Form

Pet ownership is a serious responsibility. This policy of Kootenai Pets for Life is to assure that each
person who adopts a pet is aware of the responsibility & that each is capable and willing to accept that responsibility morally, physically, & financially. The pets that have come into our care have been rescued once and our goal is to see that they are placed in caring, life-long homes the second time around.

The following questionnaire has been designed to aid both you and Kootenai Pets for Life in deciding if you and/or your family is indeed at this moment adequately prepared to assume the type of responsible ownership which we are endeavoring to assure for our adoption animals. Please be sure to answer all applicable questions and feel free to add your own comments.

I certify that the following information is true and correct to the best of my knowledge. I understand that KPFL reserves the right to deny the adoption of any animal.

The specific dog I am interested in is .

Other (please describe)

Date

My Name is

Please fill in your e-mail address so we can get back to you

Physical Address

City/State/Zip

Home Phone Work Phone

Do you own or rent a: house, condo, apartment, mobile home,

other (please describe)

Do you have your landlord's permission to adopt this dog? yes, no, don't know

Landlord's name
Phone

Are all adult members of your household in favor of adopting a dog? yes, no, don't know

Does anyone in your household have allergies to animals? yes, no, don't know

Who will be primarily be responsible for your new dog's: training? ;
feeding? ; general care?

Do all members of your household understand that it takes time for a dog to adjust to a new environment?
yes, no, don't know.

Which of the following characteristics are you looking for in your new dog? watchdog, family companion, hunter, gift. If gift, for who?

Responsible Pet Ownership

One of the KPFL major concerns is that all pets be properly cared for by their owners

Are you aware that the average monthly cost of feeding and caring for a dog is about $40-$50 per month, and can be substantially higher? yes, no. I would like more information.

Will someone be home during the day? yes, no, sometimes

What pets do you currently have in your household?

Kind Neutered: Yes, No; Vaccinated: Yes, No;
Time Owned:

Please list pets owned in the past ten years:

Kind Neutered: Yes, No; Vaccinated: Yes, No;
What Happened to Pet:

Veterinarian's Name:

Phone:

Personal Reference:
Phone:

Pet Safety
A county-wide leash law requires that dogs be kept on a leash or secured at all times. This helps protect your dog from running loose, chasing other animals and getting hit by cars.

How will you keep your dog on your property? fence, trolley, chain, training,
other (please describe)

If you plan to keep the dog outdoors, describe the outdoor shelter: porch, garage,

dog house, other (please describe)

Where will the dog be kept during the day? indoors, in and out, in yard, at work

Will someone be home during the day? yes, no, sometimes

In order to verify information KPFL may want to inspect the premises where your pet will be kept. Is this acceptable to you? yes, no, don't know

Please list any comments or questions you have

I understand the Kootenai Pets for Life, Inc. is under no obligation to adopt the animal described in this Application to me for any reason whatsoever. I further understand that representatives of KPFL will contact the references listed above for suitability for adoption & pet ownership. If I am approved for adoption, I agree to execute an Adoption Agreement & be bound by the terms thereof.

The undersigned releases and hold harmless the Kootenai pets for Life, Inc., its employees, agents, officers and directors, from any and all liability which may arise out of any verification of the information contained herein. Kootenai Pets for Life, Inc. agrees that it shall keep information received from such verification confidential.

The undersigned further releases and holds harmless the veterinarian(s) listed on this form hereof, and such veterinarian's clinic, employees, agents, officers and directors, from any and all liability which may arise from information conveyed by such veterinarian or such veterinarian's clinic, employees, agents, officers and directors, to the Kootenai Pets for Life, Inc. as a result of inquiries made in connection with this Adoption Application.

If you would like to keep a copy for your records, you must print it before you hit the submit button.