| How Long Have You Lived at Your Current Adress? (*) |
how long have you lived at your current address? |
|
| Phone Number (*) |
Please enter your phone number |
|
| Cell Phone |
Please enter a cell phone number |
|
| Email Address |
please enter your email address |
|
| Best Time to Call |
Please tell us when the best time to call you is |
|
| Occupation |
Please tell us your occupation |
|
| Business Address |
Invalid Input |
|
| Business Address Continued |
Invalid Input |
|
| City |
Invalid Input |
|
| State |
Invalid Input |
|
| Zip Code |
Invalid Input |
|
| Do You Want to Adopt or Foster (*) |
Please tell us if you want to adopt, foster or both? |
|
| How Many Children do you Have (*) |
Please tell us how many children you have |
|
| How Old Are They |
Invalid Input |
|
| What Breeds of Dogs Have Your Children Lived With |
Invalid Input |
|
| |
|
|
| What Best Describes Your Home (*) |
Please describe your home |
|
| Do You Own Your Home (*) |
Please tell us if you own your home |
|
| Does Your Home have a Yard (*) |
Please tell us if you have a yard |
|
| If You Have a Fence, How High is it? |
Invalid Input |
|
| If Adopting a Cat, Are Your Screens Secured |
Invalid Input |
|
| Why Do You Want a New Pet (*) |
Please tell us why you want a new pet |
|
| Is Everyone In Agreement (*) |
Please Tell us if Everyone is in agreement about a new pet |
|
| Where Will Your Pet Spend Most of Its Time (*) |
Please tell us where your pet will spend most of its time |
|
| If Other Please Specify |
Invalid Input |
|
| What Provisions will be Made for Your pet if Alone During the Evening? (*) |
please tell us what provisions will be made for your pet if alone during the evening? |
|
| What Provisions will be Made for Your Pet When You go on Vacation? * (*) |
Please tell us what provisions will be made for your pet when you go on vacation? |
|
| What Gender of Pet Would You Like? (*) |
Please tell us the gender of the pet you would like to have |
|
| What Age Range (*) |
Please tell us the age range of the dog you are looking for |
|
| Is There a Particular Pet From the Web Site You Are Interested In |
Invalid Input |
|
| What Activities do you Plan To Do with Your Dog |
please tell us what activities do you plan to do with your dog? |
|
| Will This Dog be used as a Guard Dog (*) |
please tell us if the dog will be used as a guard dog |
|
| Do You Have Any Pets Now (*) |
Please tell us if you have any pets |
|
| If So List Type, Breed, Age and Sex |
Invalid Input |
|
| Tell Us About The Pets You Have Had In The Last 10 Years |
Invalid Input |
|
| Have You Had to give up a pet? Or have a pet become Lost or Injured? (*) |
Please tell us if you have had a pet lost or injured |
|
| If Yes, Please Explain |
Invalid Input |
|
| |
|
|
| Your Vets Name (*) |
Please enter in the name of your vet |
|
| Vet's Phone Number (*) |
Please enter in the phone number of your vet |
|
| What Persons Name is Your Pet Listed Under at the Vet (*) |
Please tell us who your pet is listed under at the vet |
|
| Are Your Pets Current on Vaccinations (*) |
please tell us if your pet is up to date on their vaccinations |
|
| Are Your Pets Spayed/Neutered (*) |
please tell us if your pet is spayed or neutered |
|
| Are Your Pets on Heartworm Preventative (*) |
please tell us if your pet is on heartworm preventative |
|
| If So What Brand |
Invalid Input |
|
| When Did You Visit the Vet Last (*) |
please tell us when was the last time you took your pet to the vet |
|
|
References: Please provide the name and contact information of two persons, not related to you, who are able to discuss your
pet-owning abilities and overall character. This could be a friend, co-worker, neighbor First Reference: |
|
| First Name (*) |
Please enter in the first name of your reference |
|
| Last Name (*) |
Please enter reference last name |
|
| Phone Number (*) |
Please enter in your reference phone number |
|
| Email Address (*) |
please enter an email address |
|
| Street Address (*) |
Please enter your references street address |
|
| City (*) |
please enter in a city |
|
| State (*) |
please choose a state |
|
| Zip Code (*) |
please enter in a zip code |
|
|
Second Reference: |
|
| First Name (*) |
Please enter in second reference name |
|
| Last Name (*) |
please enter in second references last name |
|
| Phone Number (*) |
Please enter in your second references phone number |
|
| Email Address (*) |
please enter your second references email address |
|
| Street Address (*) |
please enter in your second references street address |
|
| City (*) |
please enter in your second references street address |
|
| State (*) |
please enter in your second references state |
|
| Zip Code (*) |
please enter in your second references zip code |
|
| What Type of Training Have You Done with Your Pet in the Past? |
Invalid Input |
|
|
By choosing to adopt through AHR, you are agreeing that you will enroll and complete a Basic Obedience Course |
|
| What trainer will you use? If you are not sure we can make recommendations. |
Invalid Input |
|
| I Agree to Pay the $400.00 Adoption Fee and I am Aware that it is Non-Refundable (*) |
Are you willing to pay the adoption fee |
|
| I Agree That all The Information on this Form is True (*) |
Please confirm all information is true |
|
|
I certify that the information I have provided on this form is true, correct, and accurate. I am financially and physically able to care for the animal that I adopt. I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreement. I understand that there is no obligation to adopt an animal to me, now or in the future. |
|
| Signature - Please Type Full Name (*) |
Please type in your full name |
|
| Type in Your Initials (*) |
Please type in your initials |
|
| date (*) |
please type in today's date |
|
| Submit Application |
|
|
