| Name of dog you wish to adopt |
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Please indicate below that you are aware that there is a $175
(non-refundable unless approved by committee, minus a $50 processing fee) adoption
fee that is collected at the time of adoption. No fees are collected
prior to adoption. This fee helps fund the care
and medical treatment of adoptable dogs. 4 Paw Sake, Inc. ensures that
all dogs are spayed/neutered and up-to-date on all shots prior to being
adopted.
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| I
am aware of the fee |
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| First Name
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| Last Name
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| Address |
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| City
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| State |
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| Zip Code
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How long at this address? |
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| Home Telephone Number
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| Work Telephone Number
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| Email Address |
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| Marital Status |
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| Place of Employment |
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How long at this job? |
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| How did you hear about us? |
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| Why do you want to adopt a dog? |
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| Breed Preference |
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| Age |
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| Size |
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| Activity Level |
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| Gender |
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| Where will the dog be kept when no one is not at home? |
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| Where will you keep the dog when someone is home? |
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| How many hours per day will the dog be alone? |
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| Where will
the dog sleep? |
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Who will be primarily responsible for your dogs care? |
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| Do all members of your household want a dog? |
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| Is anyone in your household allergic to dogs? |
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| Do you have a fenced-in yard? |
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| What type of fence do you have? |
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| If other, please describe |
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| How tall is the fence? |
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| How do you plan to exercise your dog? |
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What is the percentage you will keep the dog inside? |
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What is the percentage you will keep the dog outside? |
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| Will you obedience train your dog? |
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| Have you ever surrendered a pet to a shelter, other
agency or another person? |
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| If yes, please explain |
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What will you do if your dog develops behavioral problems? |
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Are there any behaviors/traits that would cause you to not keep the dog
for the rest of his/her life |
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| Veterinary Information |
| Do you currently have a vet?
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| If yes, please provide the veterinarian's information below |
| Vet Name |
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| Vet Street Address |
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| Vet City, State, Zip |
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| Vet Telephone |
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| How many adults are in your household? |
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| Please list ages of adults... |
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| How many children are in the household? |
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| Please list ages of children... |
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| Please list ages of children who may visit you (e.g.
stepchildren, grandchildren) |
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| Do you have any other pets in the household? |
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| Please list any other pets, their age, type of animal,
whether they are spayed/neutered... |
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| Number of pets you had in the last 5 years |
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How does a dog get heartworm and how do you prevent it? |
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How do you plan on preventing fleas and ticks? |
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What is the parvo virus and how is it contracted? |
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| Where will you and your pet live? |
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| If other, please describe... |
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| Do you rent or own? |
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| If rent, please provide landlord name and address
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| Landlord name |
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| Landlord street |
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| Landlord city, state, zip |
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| Landlord telephone |
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| Is there a limit on the size of dogs? |
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| Do you have a plan for your dog if you die, have to move
or can no longer care for your pet? Please explain.. |
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| Do you have a plan for a lengthy period of time
(vacation, emergency travel, or work travel)? Who will take care of the
dog in your absence? |
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| Would you agree to a home visit to ensure it is secure
for the dog? |
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| Do
you understand that dogs may live for 14 - 18 years. Do you understand
that this dog is totally dependent upon you for food, shelter, health
and veterinary care? Are you willing and able to make this life-long
commitment to a dog as a family member? |
| I understand and will make this commitment |
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Please List 3 Personal References (not relatives), phone number and relationship to you |
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