| Adopt a Homeless Animal P.O. Box 65351 Baltimore, MD 21209 410-239-0771 aaha.petfinder.org Click "Edit", "Select All", "Copy" and then "Paste" onto a blank email. Once you have completed the application, forward the email to [email protected]. Someone will review your application and get back to you. Name of Dog(s) Applying for: ___________________________________________________________________ Todays Date: _____________________ Applicant Name: _____________________________________________________________________________ Address: __________________________________________ City/State/Zip: ____________________________ Email Address: _____________________________________________________ Home Phone: (___)_________________ Work Phone: (__)__________________ Cell Phone: (___)___________ We are pleased you are interested in adopting a homeless animal. The following information is requested so that we can assist you in selecting a new pet. The animals welfare is our highest priority. This application is designed to help us determine if the adoption is in the animals best interest as well as helping you find an animal most compatible with your lifestyle. Thankyou for wanting to save a life! 1. Why do you want to adopt a dog? _______________________________________________________________________ 2. What do you think are the most important responsibilities in owning a dog? ______________________________________ ___________________________________________________________________________________________________ 3. For whom are you adopting the dog? ____self ____gift 4. Do you understand that some of the dogs may not be housebroken and that changing the environment of the dog may cause the dog to have accident and or destroy accessible household items? Are you willing to take the time to housebreak and train the dog? ____yes _____no 5. If a disciplinary or behavioral problem arises with your pet, what steps will you take to work on it? __________________ ___________________________________________________________________________________________________ 6. Does any member of the family have any allergies to animals? ____yes ____no please explain if yes ________________ ___________________________________________________________________________________________________ 7. Please list the pets you currently have in your household: Pets Name Breed Spayed/Neutered UTD on Vaccines Age Indoor/Outdoor a.) b.) c.) d.) 8. Please list any other pets you may have had and why they are no longer with you: __________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 9. List name & phone # of each vet where your animal(s) received care over the last 10 years: Vets Doctor(s) Phone Number Name records are under Date of last visit a.) b.) c.) d.) 10. Name of the vet you will use for your new pet? _____________________________________________________________ 11. How many people currently reside in your household? _______________________________________________________ 12. Are there any children in the household? _____yes _____no Ages _____________________ 13. Who will be responsible for the care of this pet? ____________________________________________________________ 14. Who will take care of the dog in the absence of the primary caretaker? ____________________________________________ 15. Do you own or rent your residence? ____own ____rent a. If you rent,what is the name and telephone number of your landlord? ___________________________________________ b. Are pets allowed? ____yes ____no If yes, what type/size? ________________________________________________ c. In what type of home do you reside? (house, condo, townhouse, duplex, apartment, mobile home) ____________________ 16. Do you have a fenced yard? ____yes ____no (Note: Secure, fully fenced yards are typically required for households in which there are children under age 12. For some dogs, fences of minimum 5 to 6 ft are required.) a. If yes, how high is the fence? _________________________________________________ b.What type of fence is it? _____________________________________________________ c. Are there any gaps or holes that an animal can use to escape? _______________________________________ d. If your yard is not fully fenced, do you plan to fence in an area for the dog? ____yes ____no 17. Would you walk/exercise your dog on-leash or off-leash or both? __________________________________ 18. Where will the dog be kept? ____indoors only ____outdoors only ____both 19. How many hours will the dog be unattended? _________________________________________ 20. When you are home, where will the dog be kept? ____________________________________________________ a.Where will the dog sleep? __________________________________________________________________ b. When no one is home (i.e. at work, shopping) where will the dog be kept? __________________________________ 21. Are you aware of the $150 non-refundable fee to help offset medical and boarding fees? _________________________ 22. Please list what kind of routine veterinary care you plan to provide for your pet? ________________________________ __________________________________________________________________________________________________ ___________________________________________________________________________________________________ 23. What reading have you done to prepare for a new dog, and/or other steps taken? __________________________________ ____________________________________________________________________________________________________ 24. Are you considering taking obedience training? ____yes _____no 25. Would you be willing to obtain a crate if recommended for a particular dog? ____yes ____no 26. Please list any preferences you have in adopting a dog (age, sex, breed, personality, etc) _____________________________ 27. Have you ever been convicted of a felony or criminal charge or been put on probabtion? ____yes ____no If yes, please explain ________________________________________________________________________________ 28. Please list references that are familiar with your life style (One that is a relative, two that are not related) Name Address Telephone Number a.) b.) c.) I have read the above information and have filled out this application honestly. I understand that omission of the information and/or failure to answer all the questions and sig the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Adopt a Homeless Animal reserves the right to annul the adoption and reclaim the animal. I give Adopt a Homeless Animal permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this reviwe, I agree to a home check and a yard visit on a mutually agreed date by an Adopt a Homeless Animal member before an adoption decision has been made. In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal and other applications received on this animal. I understand it is Adopt a Homeless Animals perogative 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 by Adopt a Homeless Animal, I am free to apply and undergo the application process in the future. Signature ________________________________________________________ Date ______________________________________________________________ |
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