IF YOU FIND A PET YOU ARE INTERESTED IN ADOPTING PLEASE COPY THIS APPLICATION, FILL IT OUT AND PASTE INTO AN EMAIL TO: Christine@Kirbysfriends.com . !ADOPTION APPLICATION! Name: _________________________________________________ Address:____________________________City_________________ State_______ Zip _____________ e-mail:______________________ Home Phone # ________________ Work Phone # ______________ Cell Phone #__________________ Best time to call: __________ Occupation: ________________SpouseOccupation_______________ PERSONAL REFERENCES Name: _________________________Phone # ________________ Relationship: ___________________________________________ Name: _________________________Phone # ________________ Relationship: ___________________________________________ Name: _________________________Phone # ________________ Relationship: __________________________________________ Do you own or rent your home? _____________ If renting, do you have your landlord's permission to keep a dog? YES/NO Landlord Name: _____________________Phone # ______________ How long have you lived at this address? __________ Do you have a fenced yard? YES/NO if so, fence height _____ Fence type _______________ Does fencing completely enclose a yard for the dog? YES/NO If no fence, how will you handle the dog/s exercise and potty duties? ____________________________________________________ Do you have a separate fenced kennel run? YES/NO List height & size _____________ Type ______________ How many adults in household? ______ How many children _____ Age and sex of children _____________ Do you own dogs? YES/NO If so, what kind? ________________________ How Many?_______ Are they spayed/neutered? YES/NO If not, why?_________________ Do you own cats? YES/NO How many? _____ Declawed? YES/NO Other pets? ___________ Do you have a regular veterinarian? YES/NO Name ___________________________ Phone # _______________ Address _______________________ City _____________State ______Zip ______________ How many dogs/animals have you owned in the last five years? _____ Give names, age, sex, breed of each: __________________________ ________________________________________________________ What happened to them?___________________________________ _______________________________________________________ List all plans for this dog: (circle/underline/highlight all that apply) Pet Guard Hunting Other:______________________________ Where will dog spend the day? Loose in house ___ Crate ___ Basement ___ Garage ___ Fenced yard ____Fenced Kennel run ___ with shelter ___ without shelter ___ Doggie Day Care____________ How many hours on the average will the dog spend alone? _______ Where will dog spend the night? Loose in the house __ Crate __ Basement __ Garage __ Fenced yard ___ Fenced Kennel run ___ with shelter ___ without shelter ___ Other describe __________________ Who are you interested in? _______________________________ Do you agree to license this dog and give regular health care? YES/NO Are you willing/able to pay for annual vet care for vaccinations, heartworm testing, teeth cleaning, check-ups,? YES/NO For emergency expenses? YES/NO Do you agree to contact Kirby's Friends Animal Rescue if you can no longer keep this dog? YES/NO Would you be willing to let one of our representatives visit your home by appointment? YES/NO If not, why? _______________________________________________________ I understand that this is an adoption application and NOT A CONTRACT. All of the above information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with adequate food, water, in home shelter, training, affection, and medical care. I am in full agreement with these terms of adoption. German Kirby's Friends Animal Rescue is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household. Applicant Signature: ____________________________________ Date:________________ Parent Signature if Applicant is Under 18 Years old: _______________________________________
