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Name of dog this application is for
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Tell us a little about yourself...
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Applicants Name(s)
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Address
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City
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State
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Zipcode
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Home Phone
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Email address
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Please make sure that you're email address is correct,
and that it will accept messages from us.
If more information is needed we will contact you by email,
and if it bounces you're application will take longer
to process. The longer your application takes to process,
the less likely that the animal you want to adopt will
still be available.
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Is this animal going to be a gift?
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Yes
No
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If yes, for whom?
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Please provide employment information...
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Company Name
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Address
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City
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State
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Zipcode
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Work Phone
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Tell us a little about your home environment...
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Do you live in a
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House
Apartment
Mobile Home
Condo
Dormitory
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Do you own or rent your residence?
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Rent
Own
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Landlords Name and Phone Number
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How long have you lived at this address?
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Are you planning on moving in the next year?
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Yes
No
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If you are planning on moving within the next year, what will you do with your animals?
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Where will this animal be kept during the day?
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At night?
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When left alone?
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How many hours a day will this dog be left alone without human companionship?
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Do you travel often?
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If so, how will you provide for the animal while you are away?
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Ages of any children living in your home
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Will this be your childrens first experience with a dog or a puppy as part of the household?
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Yes
No
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Does anyone in the household have known allergies to any animals?
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Yes
No
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If yes, what type of animal?
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What would you do if someone in the household became allergic to the dog after you adopt it?
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Are you familiar with crate training?
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Yes
No
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Would you crate train this dog if it was necessary?
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Yes
No
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Do you have a fenced yard?
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Yes
No
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If yes, how high is the fence?
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How do you intend to train this dog?
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On my own
Obedience class
Other
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If other, please explain
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How do you plan to exercise this dog?
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How often?
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Please tell us a little about your animal experience...
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Animals currently living in your household
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Name of Vet's Office
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Name of
Vet's Office
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Vet phone number (with area
code)
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Vet
phone number (with area code)
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Please any animals owned in the past 5 years other than listed above
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Name of Vet's Office
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Name of
Vet's Office
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Vet phone number (with area
code)
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Vet
phone number (with area code)
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General Knowledge...
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Why do you want to adopt this dog?
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Will this be your first experience owning a dog?
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Yes
No
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Have you ever turned an animal into a shelter?
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Yes
No
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If yes, what were the circumstances?
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Have you adopted from us before?
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Yes
No
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If you've adopted from us in the past, how long ago was it?
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Do you still have the animal you adopted from us?
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Yes
No
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If no, what happened to it?
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Do you understand that all household pets need to go to the veterinarian on a yearly basis for shots and a checkup?
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Yes
No
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Who will be responsible for the care and cost of this animal?
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Are you prepared to incur the many expenses involved in owning a pet? (keep in mind veterinary expenses, food, toys, training, yearly license fees, grooming and boarding fees.)
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Dogs can live 15 years or longer. Can you commit to caring for an animal this long?
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Are you aware that most shelter animals have unknown medical backgrounds?
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Yes
No
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Are you prepared to provide and pay for any necessary medical treatment?
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Yes
No
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Do you intend to breed this animal?
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Yes
No
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If yes, why?
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Do you intend to spay/neuter this animal?
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Yes
No
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If no, why not?
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Are you familiar with heartworms?
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Yes
No
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Do you plan to have this dog on heartworm medication?
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Yes
No
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PLEASE READ THE FOLLOWING CAREFULLY, AND CHECK THE BOX IF APPROPRIATE
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I understand that I will not be allowed to adopt from The Animal Orphanage unless I am at least 18 years of age. By checking the box to the left, I certify that I am at least 18 years of age.
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I
understand that I must have the knowledge and consent of all adults living
in my household to adopt and animal (if applicable). By checking the box
to the left, I certify that I have the knowledge and consent of all adults
living in my household to adopt and animal.
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I
understand that I must have my landlord's consent to bring an animal onto
the property to live. By checking the box to the left, I certify that I
have permission from my landlord to bring an animal onto the property to
live (or own my home).
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I understand that The Animal Orphanage has the right to deny my application
with or without reason. By checking the box to the left, I certify that
I understand that denial of my application is always the right of Animal
Orphanage.
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I certify that the information given by me in this application
is true and complete. I further understand that any falsified information
that I give will terminate the action on the adoption process. I hearby
authorize release/disclosure of records and/or other information concerning
all of the above inquiries, including but not limited to employment information,
tenancy information and veterinarian records. The Animal Orphanage reserves
the right to refuse any adoption it considers unsatisfactory.
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By clicking the submittion button below, you agree to the above
stated contract, and confirm that all information provided is the truth
to the best of your knowledge. You also agree that this submission will
be as valid and binding as an actual signature, and upon approval for adoption
that you will sign the above form in a printed format while being witnessed
by an Animal Orphanage Representative without modification or editing.
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