First Name (required)
Last Name (required)
Your Email (required)
Date of Birth (YYYY-MM-DD) (required)
Primary Phone Number (required)
Other Phone Number
Address 1 (required)
Address 2
City (required)
State (required) —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip/Postal Code (required)
Country
Number of years you have lived at this address: (required)
Type of Residence (required) —Please choose an option—HouseDuplexApartmentCondoMobile Home
Do you rent? (required) YesNo
If yes, name of Landlord
Landlord Phone Number
List all people, including yourself, in your home- along with the ages of everyone:
What are your plans for this dog if you move?
Does everyone in your household know your plans to adopt a dog? (required) YesNo
Is anyone in your household allergic to dogs? (required) YesNo
If yes, what are your plans to control these allergies?
Please rate your household activity level (required) 1 - Low Key2345 - Moderate678910 - Highly Active
Primary Employer
Number of years you've worked there
Full or Part Time? Full TimePart Time
Address of Employer
City of Employer
State/Province of Employer State (required) —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code Country Do you have other household income? YesNo Other Employer Name Number of years you've worked there Full or Part Time? Full TimePart Time What dog of ours are you interested in? (required) Why? (required) What is your dog ownership experience? (required) —Please choose an option—I am a first-time dog ownerI have had one or two in my lifeVery knowledgeable/experienced Who will be primarily responsible for the dog? (required) Where will the dog be kept? (required, check all that apply) In the house (free roam)In the basementIn a crate insideIn a closed-off room insideIn the garageTied up outsideOutside in a kennelOther On average how many hours per day will the dog be left alone? (required) How would you resolve behavior problems such as chewing, barking, digging, fence jumping, etc.? (required) Are there any behaviors that you would be unable to live with/tolerate? Have you ever adopted from this shelter? (required) YesNo If Yes, when? Have you not been chosen or declined? (required) YesNo If Yes, please explain Have you adopted from another shelter? (required) YesNo If Yes, when? Have you not been chosen or declined? (required) YesNo If Yes, please explain Have you ever surrendered a pet to a shelter? (required) YesNo If Yes, what shelter and when? If Yes, please explain How many pets live in your home now? (required) PET #1 Name of Pet #1 Breed of Pet #1 Age of Pet #1 Pet #1 is: MaleFemale Pet #1 is Spayed or Neutered YesNo Do you still own Pet #1? YesNo Are all vaccinations current for Pet #1? YesNo PET #2 Name of Pet #2 Breed of Pet #2 Age of Pet #2 Pet #2 is: MaleFemale Pet #2 is Spayed or Neutered YesNo Do you still own Pet #2? YesNo Are all vaccinations current for Pet #2? YesNo PET #3 Name of Pet #3 Breed of Pet #3 Age of Pet #3 Pet #3 is: MaleFemale Pet #3 is Spayed or Neutered YesNo Do you still own Pet #3? YesNo Are all vaccinations current for Pet #3? YesNo Please list the same information above for any additional pets you may have in your home at this time List all of the veterinary facilities you have used for each pet: What personality characteristics do you seek in a new pet and what activities do you hope to do together? (required) Signature BY TYPING MY NAME BELOW, I CERTIFY THAT THE ABOVE INFORMATION IS TRUE TO MY KNOWLEDGE, AND I RECOGNIZE THAT ANY MISREPRESNTATION OF FACT MAY RESULT IN LOSING ADOPTION PRIVILEGES. I UNDERSTAND THAT COMPLETING AN APPLICATION FOR ANY LISTED ANIMAL DOES NOT GUARANTEE THE ACCEPTANCE AND FINALIZATION OF THE ADOPTION FOR SAID ANIMAL. IN UNDERSTAND THAT IF MY APPLICATION IS NOT CHOSEN FOR SAID ANIMAL, I MAY STILL BE ELIGIBLE TO ADOPT ANOTHER ANIMAL AT ANOTHER TIME FROM BOB'S HOUSE FOR DOGS AND THAT MY APPLICATION WILL BE KEPT ON FILE AT BOB'S HOUSE FOR DOGS I AUTHORIZE INVESTIGATION OF ALL STATEMENTS IN THIS APPLICATION AND UNDERSTAND THAT VETERINARIANS, OTHER ANIMAL SHELTERS, LANDLORDS, ETC. MAY BE CONTACTED. I CERTIFY THAT I AM AT LEAST 18 YEARS OF AGE. I UNDERSTAND THAT THIS APPLICATION IS NOT AN ADOPTION CONTRACT, AND THAT THE ADOPTION WILL BE DELAYED UNTIL MY APPLICATIONS (AND OTHER APPLICATIONS THAT MAY BE RECEIVED FOR THE SAME ANIMAL) HAVE BEEN FULLY PROCESSED. I agree to the terms stated above YesNo Name: (required) Date (YYYY-MM-DD) (required)
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