Adoption Application

Name of pet you want to adopt:
Your Name:
Email Address:
Age:
Marital Status:
Home Address City State Zip:
Home Telephone:
Cell Phone:
Employer:
Working Hours:
How did you hear of us:
Why are you adopting:
Is it a gift for someone:
Why did you chose this pet:
Expected temperament:
Experience with breed:
Type of home:
Own or Rent?	Own Rent
If you rent, landlords name & phone:
Pet restrictions:
How many adults at home:
How many children at home and their ages:
When home alone dog will stay:
Do you have a fenced in yard:	Yes No
Exercise methods:
Expected yearly vet expenses:
Would get rid of pet If:
Unacceptable behaviors:
Behavior correction methods:
Do you have pets now:
Pet 1 Name: Breed: Age: Sex: Long Owned:
Pet 1 Explanation of death:
Pet 2 Name: Breed: Age: Sex: Long Owned:
Pet 2 Explanation of death:
Pet 3 Name: Breed: Age: Sex: Long Owned:
Pet 3 Explanation of death:
Vet 1 Name, facility, & phone #:
Vet 2 Name, facility, & phone #:
Used heartworm preventative on past Pets- If so what brand:
Use heartworm preventative on current pets- If so what brand:
Where did you last purchase Heartworm preventative:
Vaccinations kept up to date:
Are your current pets spayed & neutered?
What age dog would consider adopting:
Would you adopt abused dog:
Would adopt special needs dog:
Do you Agree to return pet to GALPR if cant care for pet?:
The above info is true:	Yes No
Understand adoption donation is between $200-$300:	Yes No
Signature Legal:

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