Adoption Form

Adoption form

Name of Dog

Date:

I am 23 years of age or older

Section One - Contact Information

First name

Last name

Email

Cell Phone

Home Phone

Work Phone

Address

City, State, Zipcode

Section Two - HOUSING

Which best describes your housing:

House

Townhouse

Apartment/condo

Other

Do you own or rent?

Own

Rent

If you rent, please list your landlord name/phone #:

How long have you lived at present address?

Number of adults in the house:

Number of children in the house:

Please list the ages of children:

Are all adults in the household aware that you are adopting a dog?

Yes

No

Who will be the primary caregiver for your new dog:

Does any member of your household have an allergy to dog hair/dander?

No

Yes

Explain your decision for adopting a dog:

Section Three - Pet Information

Name and phone number of current/past vet:

Please list the City and State the vet is in:

Do you authorize your current/past vet to speak with a RAWL representative?

Yes

No

Please list the following background information on current/former companion pets - See info needed below:

Info Needed for Each Pet:

Type of animal/breed

Age

Sex

Spayed/Neutered

Vaccines Current

Years Owned

What happened to the pet

Are current pets compatible with other animals?

Yes

No

If no, please explain:

Section Four - General Information

Do you have a yard? If yes, what is the size? Is it fenced in? What is the height/type of fence? Is there a gate?

Do you have a doghouse, outside pen, or kennel? If so, please describe.

Are there times when the dog will be tied outside?

Yes

No

If yes, please explain:

Is someone going to be home during the day?

Yes

No

How long will the dog be left alone?

Where will the dog be kept during the day when home alone?

Where will the dog be kept during the day when you are home?

Where will the dog sleep at night?

When you go on vacation or travel, who will care for the dog?

If the dog is not house-trained, what method will you use to train it?

Explain how you will discipline the dog:

Do you plan to attend obediance classes for your new dog?

Yes

No

How much do you expect to annually spend on medical bills for your dog?

Pet ownership is a lifetime commitment, what provisions would you make/take if you:

Move:

Divorce

Become incapacitated:

Have you filled out a RAWL adoption application before? If yes, please list when.

Yes

No

If yes, please list when:

Are you aware that RAWL reserves the right to conduct home visits?

Yes

No

I certify that the information above is true and understand that false information will result in nullification of this application.

Signature

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Adoption Form

Adoption form

Reminder: RAWL is a non-profit IRS 501(c)(3) organization.

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