Home Adoption Application Adoption Application Name of pet(s) you are interested in adopting: Why do you want to adopt a dog? PERSONAL INFORMATION:Name:Age:Occupation:Address:City, State, Zip:Home Phone:Mobile Phone:Work Phone:Email Address:Do you rent or own? Rent Own If you rent, provide Landlord name, address and phone:Do you have permission from your landlord to have a dog in your home? Yes No Do you have a fenced yard? Yes No If so, what type/height?If you do not have a fence are you prepared to walk your dog multiple times daily in spite of weather conditions (cold, hot, rain, snow, etc,)? Yes No Do you have children in the home ? Yes No Ages:QUESTIONS ABOUT YOUR FUTURE FAMILY MEMBER:Do you plan to crate train? How will you work with house training the dog?Will the dog be an inside dog or outside? Inside Outside CURRENT PET INFORMATION:Name, Age, Breed, Spayed/Neutered (Yes or No)Name, Age, Breed, Spayed/Neutered (Yes or No)Name, Age, Breed, Spayed/Neutered (Yes or No)Is your current pets Up to Date on their Rabies shot? Yes No Is you current pets Up to Date on their yearly vaccinations? Yes No PREVIOUS PET INFORMATION:**Please list information for all vets your living and deceased pets have seen.Current and/or Past Vet Name(s), Practice Name, Address, City/State/Zip, Phone Number **Please be sure to give your vet(s) permission to release information to Tipton County Animal Shelter. We will be calling the vet reference prior to any adoption decisions. Please provide name, email, AND phone number for 2 personal/professional references:Name, Email & Phone NumberName, Email & Phone NumberAGREEMENTS FOR ADOPTION (PLEASE INITIAL):I will keep my dog on a year round routine of heartworm preventative.I will provide flea/tick control, as needed. I will not chain or tie-up my dog and leave it outside alone.SIGNATURE: By checking this box I confirm all information is correct DATE:PRINT NAME:
