Education and Adoption Services
127 San-Jo Drive Grantville Pa 17028
Phone or Fax (717) 469-7325
Email to: doggieden@aol.com

Adoption Application
Pet Information:
Name or Type of pet interested in:
Human Information:
Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Email:
A valid email address is required. If you do not have an email address leave this blank.
People in your household:
# of Adults: Ages:
# of Children: Ages:
Personal References: (no family members please)
Name: Phone:
Name: Phone:
Name: Phone:
Veterinarian used now: Phone:
Veterinarian used previously: Phone:
Other pets currently in your care or on your property (such as dog, cat, age, how many, are they kept inside or outside):
Are your pets fixed?
Yes No
Previous pets and what happened to them:
Do you:
Rent Own
If you rent, please list your landlords name and phone number:
Comments:
Please mark the "I Agree" checkbox, by doing so you certify that all information is complete and accurate.
I Agree  ***REQUIRED***