First Name:

Initial

Last Name:

Email address:

Pets Name:

State and Drivers License Number

Street Address:

City

State

Zip

Home Phone:

Cell Phone:

Work Phone:

Employer Name and Address:

Spouse Name:

Employer Name and Address:

Number of Adults (over age 18) in household:

Name of each adult in household:

Who will be the primary caretaker of this pet?

Number of children in household:

Why do you want to adopt this pet? ie companion for child, protection, gift companion for other pet, house pet, working dog, cat mouser. etc

Do all of the adults in the house consent to this adoption?

Ages of children in household:

yes no

Does anyone in the house have pet allergies?

yes no

Other animals in household:  Note: please list by - | name | m/f | age | species |

Do you own or rent?

If you rent, please provide landlords name, address and phone number:

If you rent, does your
landlord allow pets?

own rent

yes no

Do you live in a:

If other please explain:

How long at
current address?

house apartment mobile home condo town house other

yard

yard fenced?

fence height

pool

pool fenced?

pet door

yes no

yes no

yes no

yes no

yes no

Do you plan on moving
in the next 12 months?

If no fence, how will you provide your dog's exercise/bathroom needs?

yes no

This pet will be kept?

mostly inside totally inside mostly outside totally ouside both inside and outside

How many hours per day
will the pet be home alone?

If you do not have a securely fenced yard, how will you ensure that your dog does not escape?

How will you ensure your dog stays on your property when you are not there?

in house kennel dog run fenced yard chain or rope garage patio on leash in house in crate in house other

Name of your veterinarian or animal clinic (required)

Phone number and address of your vet (required)

Will you authorize a visit to your home before or after adopting a pet?

Are you willing to get obedience training if recommended?

yes no

yes no

Please feel free to provide any other information you feel is important for this adoption application.  

Yes. By digital signing and submitting this form I agree that if for ANY reason I cannot keep the dog, the dog will be returned to Golden Bone Rescue and Rehab.

Yes. By digital signing and submitting this form I agree that all puppies adopted through Golden Bone Rescue & Rehab must be neutered / spayed at the appropriate age. Certificate of spay / neuter must be sent to Golden Bone Rescue to confirm. Golden Bone Rescue & Rehab reserves the right to revoke any adoption if the puppy has not been spayed or neutered.

Date

Name (your digital signature)