DVAR
ADOPTION APPLICATION FORM
It is very time-consuming for us to check your references and work at matching up the right Akita with the right family/person. The process is not an overnight one. And then after that. we have had Akitas sit and wait extra months for a home because people choose a dog and then did not follow through with adopting him/her. It is not fair to the Akita and it is not fair to us.To ennsure that you are as committed to adopting from us as we are to working tirelessly for you, we require a $25 deposit be submitted with this application; it will be applied toward the adoption fee.
Fill out this application completely. Please remember that many of our dogs lost their original home because they were mis-matched with their former owner's personality, facilities, and /or life style. For the sake of both the dog and you, we need the following information. If you would like to add more which you feel would help us find the best dog for you, please do so on a seperate paper.
NAME ___________________________________________________ PHONE ____________________________
ADDRESS ___________________________________________________________________________________
CITY _________________________ STATE _________________ ZIP _______________________
DRIVER'S LICENSE # ______________________________ SS # __________________________________
WHY DO YOU WANT AN AKITA? _________________________________________________________________
___________________________________________________________________________________________
WHAT OTHER ANIMALS DO YOU CURRENTLY HAVE (SPECIES, BREED OF CANNINE?) _____________________
___________________________________________________________________________________________
IF CANINE, WHAT AGE? ___________ WHAT SEX? ____________ SPAY/NEUTERED?_______________
HAVE YOU OWNED LARGE DOGES BEFORE? ______ IF SO, WHAT HAPPENED TO THEM? ___________________
___________________________________________________________________________________________
PEOPLE IN YOUR HOUSEHOLD:
HOW MANY? ____________ WHAT RELATIONSHIP TO YOU? ________________________________________
IF ANY CHILDREN, WHAT AGES AND SEXES? _____________________________________________________
WHO IS HOME DURING THE DAY? _______________________________________________________________
YOUR HOME :
DO YOU OWN YOUR OWN HOME: ______ IF RENTED , DOES LEASE PERMIT LARGE DOGS?_______ (COPY REQUIRED)
HOW LONG HAVE YOU LIVED HERE? _______ IF LESS THAN TWO YEARS, GIVE PREVIOUS
ADDRESS: ___________________________________________________________________________________
____________________________________________________________________________________________
WHAT IS SIZE OF LOT? ___________________ IS IT FENCED? ______________
IF SO, WHAT HEIGHT AND MATERIALS IS THE FENCE?
_____________________________________________________________________________________________
IF NOT, ARE YOU WILLING TO PROVIDE FENCED AREA OR KENNEL RUN? _______________________________
WHERE WILL DOG BE DURING THE DAY? ____________ AT NIGHT? ________
WHEN YOU ARE AWAY OVERNIGHT? _________
IF THERE ARE NO CHILDREN AND / OR OTHER ANIMALS LIVING IN YOUR HOME, ARE THERE FORESEEABLE TIMES WHEN THE AKITA WOULD HAVE TO SPEND VISITING TIME WITH CHILDREN OR
OTHER ANIMALS? _________________
EXPLAIN:
_________________________________________________________________________________________
EMPLOYMENT:
WHAT IS YOUR OCCUPATION? ___________________________ HOW LONG EMPLOYED? ______________
NAME AND ADDRESS OF YOUR EMPLOYER:
__________________________________________________________________________________________
IF LESS THAN ONE YEAR, NAME AND ADDRESS OF PREVIOUS EMPLOYER:
___________________________________________________________________________________________
WHAT ARE YOUR WORK HOURS? ________ IF ANYONE ELSE IN YOUR HOUSEHOLD IS EMPLOYED,
IDENTIFY THEM AND GIVE NAME AND ADDRESS OF EMPLOYER AND WORK HOURS
___________________________________________________________________________________________
HAVE YOU OR ANYONE IN YOUR HOUSEHOLD EVER BEEN CHARGED WITH AND/OR CONVICTED
OF ANY CHARGE RELATED TO ANIMALS OR CHILD ABUSE?_________ IF SO, EXPLAIN
____________________________________________________________________________________________
____________________________________________________________________________________________
REFERENCES:
PLEASE PROVIDE NAME, ADDRESS AND PHONE NUMBER FOR THE FOLLOWING:
VET:
___________________________________________________________________________________________
LOCAL INDIVIDUAL (NOT A RELATEIVE) WHO KNOWS OR HAS KNOWN YOUR OTHER ANIMALS:
___________________________________________________________________________________________
NEIGHBOR IMMEDIATELY ADJACENT TO YOUR PROPERTY: ___________________________________________
___________________________________________________________________________________________
MAY WE VISIT YOUR HOME AND CHECK YOUR REFERENCES TO VERIFY THE ABOVE INFORMATION?
___________________________________________________________________________________________
DO YOU, THE UNDERSIGNED, UNDERSTAND THAT ANY MISREPRESENTATION OF YOURSELF OR ANY UNTRUTHS IN THE INFORMAITON WHICH YOU HAVE PROVIDED HEREIN WILL INVALIDATE ANY FUTURE ADOPTION AGREEMENT AND WILL GIVE DVAR THE RIGHT TO RECLAIM THE AKITA WITHOUT REFUND OF THE ADOPTION FEE AND WITHOUT HAVING TO RESORT TO COURT PROCEDURE: _____________________________
____________________________________________ _______________________
SIGNATURE OF APPLICATION DATE
REMEMBERING THAT SAME-SEX AKITAS RARELY CO-EXIST PEACEABLEY AND THE MAJORITY OF RESCUE DOGS ARE ADULTS, WHAT SEX AND GENERAL AGE CATEGORY OF DOG DO YOU HAVE IN MIND TO ADOPT? _______________________________________________________
IS THERE A PARTICULAR DOG(S) ON THE LIST OF ORPHANS WHICH INTERESTS YOU?
Pleae return this application and your $25.00 application fee to :
DVAR, PO Box OR EMAIL A COMPLETED FORM (with check in the mail; DVAR will wait for check to begin to process this app!)
We will contact you and set up an appointment so that you can come to the kennel to meet the orphans or we can discuss with you which Akita would seem best and arrange to bring him/her to you.
