Dog Adoption Application DOG Adoption Form FAAS - Dog Adoption Application Please give careful consideration to adopting a dog. Be sure your lifestyle allows the time, patience & expense this pet will need over the years. Be ready for a 10-15 year commitment, Animals are not toys or short-term commitments Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Primary Phone*Secondary PhoneAre you currently employed?*Please ChooseYesNoEmployer Name* Employer Phone*Your Occupation* How did you hear about us?* Name of dog you're applying for*(Or enter "not sure.") Why do you want a rescue dog?*Have you submitted any applications with other rescues?*Please ChooseYesNoDoes your town or city have any breed restrictions?*Please ChooseYesNoNot SureWhat are the restrictions?*Have you ever been cited for a Leash Law or Dog License violation?Please ChooseYesNoAre you aware of your town/city's ordinances regarding dog licensing?*Please ChooseYesNoNot SureAre you aware of any Leash Law in your city/town?*Please ChooseYesNoNot SureDo you agree that the dog WILL NOT be used for fighting, breeding, illegal activities or be found at any time in a location where its presence is illegal?*Please ChooseYesNoDoes any member of your family have allergies, or Asthma?*Please ChooseYesNoNot SureIf yes, please explain*Are you aware that dogs can shed all year long?*Please ChooseYesNoDo you live alone?*Please ChooseYesNoPlease list names and ages of all family members living in your home.*NameAgeRelationship to You Will your rescued dog have regular contact with children under 10?*Please ChooseYesNoMaybeIf yes or maybe, age(s)?* Have all family members met, and agreed on this dog?*Please ChooseYesNoIf no, please explain.*If you were to travel, where would your dog stay?*If you had to move suddenly, what would you do with your dog?*Have you considered the extra expenses that will come with having a dog, including food, supplies and equipment, toys, training, boarding, heartworm & flea/tick prevention, grooming, and that the cost of maintaining a healthy dog can average $500 - $1000 or more a year?Please ChooseYesNoAre you willing to take the time to housebreak a dog, and do you understand that changing a dog’s environment may cause the dog to have accidents?*Please ChooseYesNoNot SreIf Yes, how would you do so?Describe the kinds of personal situations where you might have to return your adopted dog:* Shedding Barking Chewing Doesn't Listen Moving Getting married/divorced Kids don't take care of Gets to o big Too expensive New baby Would never consider Other Other (be specific)What steps have you taken to prepare for a new dog?*Why do you want this breed of dog?*Have you researched this breed?*Please ChooseYesNoAre you willing to obtain an appropriately sized, open-wire crate, if recommended?*Please ChooseYesNoIf not, Please explain:*Do you plan to go to a professional dog trainer and/or obedience classes?*Please ChooseYesNoNot SureIf behavioral issues were to arise, how would you handle it?*Housing: Do you:*Please ChooseOwn your homeLive with parent(s)Live with fiend(s)RentOtherIf other, please describeHow long at current residence (in years)*If less than 2, enter 1 or 0Please enter a number from 0 to 99.Previous Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If you live with your parents, friends, or rent, do you have permission to get a dog?*Please ChooseYesNoIf you live in a condo, or mobile home, are you restricted to a specific size/breed dog?*Please ChooseYesNoNot sureNot applicablePlease provide the name of your landlord.* First Last If you rent and have been at current residence less than 2 years, please list previous address and name of landlord.* First Last If you rent and have been at current residence less than 2 years, please list previous telephone number of landlord.*Note: Secure, fully fenced yards may be required for homes with children under age 12. For some dogs, fences of minimum 5 to 6 ft or stockade may be required. Is your yard completely fenced?*Please ChooseYesNoPlease describe (height, material, attached to your home, any gaps, and if it's your's or your neighbor's)*Do you plan to enclose your yard in a fence?*Please ChooseYesNoDo you have or use: Ovehead run? Tie out? Who will care for, train & exercise your new dog?*How will you exercise your dog?*How many hours will the dog be home alone on a regular basis? (specify day, or evening)*When you are home where will the dog stay? (be specific)*When no one is home where will the dog stay? (be specific)*Where will the dog stay at night while you sleep? (be specific)*Will dog be allowed on furniture?*Please ChooseYesNoWhat attributes are important for the dog to have?* Good with dogs Good with cats Good with kids Size Past chewing stage Easy going Not hyper Does not matter Do you have a health preference? Choose Option Healthy Only Healthy w/minor short term problem Healthy w/minor long term problem Disabled Does not matter*Please ChooseHealthy with minor short-term problemHealthy with minor long-term problemDisabledDoes nto matterHave you ever given away, sold, or surrendered a pet?*Please ChooseYesNoIf Yes, please explain:*Do you currently own any pets?*Please ChooseYesNoCurrent Pets*Press + button to add more linesSpecies (dog, cat...)Breed (Lab, Tabby...)AgeWhat year did you get Pet 1?How did you acquire Pet 1?Up to date on rabiesUp to date on vaccinesSpayed/neuteredIndoorOutdoorVet's nameVet's phone Will you use the same vet for your new dog?*Please ChooseYesNoIf you do not currently have pets, have you had any pets in the past that you were the primary care taker for?*Please ChooseYesNoCaretaker past pet info*BreedNameAgeWhat year did you get this pet?Year deceased or last year you had this pet?Up to date on rabiesUp to date on vaccinesSpayed/neuteredIndoorOutdoor Please list any Veterinarians you may have used within the past 10 years:*Press + button to add more rowsNamePhone Number Please provide additional information you would like us to know about yourself (breed / rescue experience, etc.):Please provide names and contact information for two references, not related to or living with you, (friend, neighbor, clergy):*Click + button to add another row. By submitting this application I attest that the information provided is true and accurate and understand false information will result in denial of adoption. Also, if an omission or untruth is discovered after an adoption takes place, the City of Attleboro or the Friends of Attleboro Animal Shelter reserves the right to annul the adoption and reclaim the animal. I give permission to fully investigate the information provided as well as contact veterinarians and related officials. The adoption decision is dependent on many factors, including but not limited to the compatibility of the family to the individual animal. I understand it is the Friends of Attleboro Animal Shelter prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated I am free to apply and undergo the application process in the future. I, the undersigned, hereby specifically and forever release, discharge and hold harmless the City of Attleboro, its agents, and any other person, firm or corporation charged or chargeable with liability, their heirs, administrators, executors, successors and assigns, from any and all claims, damages, costs, expenses, loss of service, actions and causes of action in relation to adoption of the dog. I hereby authorize the Friends of Attleboro Animal Shelter the right to receive information from Veterinarians and others listed on this application. By typing my initials in this box, I have read and agree to the above statement:* EmailThis field is for validation purposes and should be left unchanged.