Dog Adoption Application

G.A.I.N. Dog Adoption Application

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please describe the pet you are interested in adopting, including breed, name, etc. *

Cell Phone Number *

Home Phone Number *

Work Phone Number *

Your Spouse/Partner's Name *

First

Last

How many years have you lived at your current residence? *

Are you planning to move soon? *

No Yes

If yes, where will you be moving to? *

Are you over 18 years of age? *

No Yes

Do you own or rent your home? *

Own Rent

If you rent your home, what type of home is it? *

Single family home Apartment / condo N/A

If you rent your home, please provide the name and phone number of the responsible property manager who will approve your having this pet at the property. *

How many adults live in your household? *

How many children live in your household? *

What are the ages of the children living in or visiting your household on a regular basis? *

Is anyone in your household allergic to dogs or cats? *

No Yes, allergic to cats Yes, allergic to dogs Yes, allergic to both

Please provide the full name and telephone number of any veterinarian who would have records of treatment of any pet you have owned within the past five years. Please also contact your vet to give G.A.I.N. ability to confirm status of vaccinations, spay/neuter, etc. as it will expedite the application process. *

Have you ever used an animal shelter or humane society before? *

No Yes

If yes, what was the reason? *

Why are you adopting a new pet now? *

Is everyone in the household in agreement about getting this pet? *

How many dogs have you owned in the past 5 years? *

How many cats have you owned for the past 5 years? *

How many other types of pets have you owned in the past 5 years? What were they? *

Do you still own any of these pets? *

No Yes

If yes, which pets do you still own? Provide the breed and name of the pet. *

If you no longer own these pets, where are they now? *

How many of your pets are/were spayed or neutered? Please indicate cat, dog, or other, and how many of each were spayed or neutered. *

How much time each day will someone be at home with this pet? *

Do you have a fenced in yard? *

No Yes

If yes, what type of fence do you have? *

How will you confine this pet when you are not at home? *

Will this pet live inside only, inside/outside, or outside only? *

Inside only Inside/outside Outside only

Please explain the living situation of your pets who are inside/outside or outside only pets. *

When your pet(s) are outside for long periods of time, is shelter available? *

No Yes

If yes, what kind of shelter? *

Have you had a pet die of distemper, parvo, leukemia, or unknown causes in the past six months? *

No Yes

If yes, please explain. *

May an authorized representative of G.A.I.N. contact you for follow-up information about your pet and your adoption experience? *

No Yes

If you do not have a reasonably current vet reference, please provide three (3) personal references. For each, include name, telephone number, your relationship to this person, and how long you have known this person.

First reference *

Second reference *

Third reference *

Attestation *

I believe I am capable of handling and interacting with the pet I propose to adopt and am financially able to care for it. I have answered these questions truthfully to the best of my ability. I understand that any misrepresentation of this information is grounds for adoption denial. Furthermore, I understand that completing this application is not a guarantee that I will be allowed to adopt this pet and that G.A.I.N. has the right and responsibility to deny any adoption.

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