Save A Dog Adoption Application You must be 21 years old and have a valid driver's license or picture ID to be to adopt. Date: ___________________ SECTION 1: PERSONAL INFORMATION First Name: ________________________ Last Name: ___________________________ Address: _______________________________________________________________ _______________________________________________________________________ City: _______________________________ State: _________ Zip+4: ______________ Home Phone: ( ) ___________ Work Phone: ( ) ____________ E-mail Address: __________________________________________________________ (required to be notified of dogs available) (PLEASE PRINT CLEARLY) Occupation: _____________________________________________________________ Dog Interested in: _____________________________________________________________ Have you applied with other dog adoption agencies? If so, let us know if the home visit is complete. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ SECTION 2: DOG INFORMATION Is this application for one or more of our currently available dogs? Yes _____ No _____ If Yes, Please list the names of the dog or dogs for which you are applying: _________________________________________________________________________ If No, please let us know what type of dog you are looking for. If you have a preference as to sex and size, please indicate that also. __________________________________________________________________________ __________________________________________________________________________ What is the OLDEST age dog you will accept? : ________ Any age is acceptable: _____ Will you accept a dog that has treatable medical problems, i.e., needs pills? Yes ____ No ___ Maybe ______ with the following conditions __________________________________________________________________________ SECTION 3: ENVIRONMENT FOR DOG Do you have a completely fenced-in back yard on your property? Yes ___ No ___ If you have no fence, how do you plan to have your new dog receive proper exercise? ________________________________________________________________________ Do all adults work full time? Yes ___ No ___ How many hours each day will your new dog be alone? _____ Hours How will you structure the dog’s time when s/he is alone? Will you use a dog walker or daycare? Please provide name of dog walker or daycare. ________________________________________________________________________ ________________________________________________________________________ Will you be feeding dry kibble and if so, what brand; If a raw diet please indicate so. ________________________________________________________________________ Obedience training is mandatory for all dogs. Do you have a trainer lined up? ________________________________________________________________________ SECTION 4: REFERENCES Please provide the contact information of a veterinarian you have used before and plan to use with your new dog? Vet references are checked. Vet Name: __________________________________ Vet Phone:( )_________ Vet records are under the name of: ________________________________________ Please provide at least two personal references, preferably your dog trainer, pet sitter, groomer or someone who knew your previous dogs, or if you’re a first time dog owner, the name of someone whose dog you have cared for. Include their name, telephone # and how this person knows you and your ability to provide a good home for a dog: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ SECTION 5: HOUSEHOLD INFORMATION Please list place of employment for yourself and your spouse, if applicable. Include the location of each employer. My Employer is: ______________________________________________________ Spouse’s Name: ______________________________________________________ Spouse’s Employer: ___________________________________________________ Residence: Own _____ Rent _____ Please note: If you own, proof of ownership will be required for the adoption process. If you rent, you must provide your landlord's contact information below so that we may verify that you are allowed to have a pet. Landlord’s Name, Address, Phone Number: _____________________________________________________ ______________________________________________________ Total number of people living in your residence (including yourself): __________ Do you have 1 or more cats? : Yes _____ No _____ List below all people who currently live at this residence, including yourself (children’s names not required, you can put daughter/son/grandchild): Name Relation to you Age ________________ ________________________________ ____________ ________________ ________________________________ ____________ ________________ ________________________________ ____________ ________________ ________________________________ ____________ ________________ ________________________________ ____________ Does anyone in your house have any known allergies to dogs? Yes ___ No ___ List below any cats, dogs, etc. who currently lives in your household: How long Kept Name Type/Breed Age? Sex/Neutered? Owned? Where? _____________ ________________ ____ ____________ _________ ___________ _____________ ________________ ____ ____________ _________ ___________ _____________ ________________ ____ ____________ _________ ___________ _____________ ________________ ____ ____________ _________ ___________ SECTION 6: HISTORY Have you owned a dog before? : Yes ______ No ______ If yes, please provide a brief history of what happened to it. If your last dog died, please state dog's name and date deceased. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ SECTION 7: DONATION INFORMATION The adoption donation ranges from $350-425 for adult dogs and $450-550 for puppies. This cost is to cover increasing transportation costs and extra health certificates for our dogs. Out of state dogs receive a medical exam and health certificate prior to transport and also after the 48 hour state-mandated quarantine. Are these terms acceptable? Yes _____ No _____ Please realize that dogs need vet care throughout their lives. If you cannot afford this donation, you may not be able to afford the appropriate vet care. Please consider this before adopting a dog. Are these terms acceptable to you? If so, please indicate by signing below: I certify that I have read the above Adoption Application and donation information and will execute same promptly upon receipt. All medical records and other pertinent information will be provided to you upon receipt of above. Signature: _____________________________________________________________ Print name: ____________________________________________________ Date ___________ Please return this application by email to adoptions@saveadog.org or fax our toll-free fax number, 877-349-9254 or mail to: Save A Dog P.O. Box 1108 Framingham, MA 01701-1108 If you have any questions, please call: Save A Dog at (508) 877-1407.