Adoption Application
Questions marked by * are required.
1. Name: *
2. Pet Applying for:
3. If not a specific pet, what breed or age of pet are you looking for?
4. Address (Street Address, City, State, Zip Code) *
5. Phone Number: *
6. Email: *
7. Employer: *
8. Do you rent? *
  • Yes
  • No
9. Is there a pet policy?
  • Yes
  • No
10. Name & Contact for Landlord:
11. Children in the home? Please list ages if yes. *
12. Is anyone home during the day? *
  • Yes
  • No
13. How many hours daily will the pet be left alone? *
14. Where will pet be when no one is at home? *
15. Is shelter provided for outside? *
16. Do you have a fenced yard? *
  • Yes
  • No
17. If yes, what type and height of fence? (i.e. 4' chain link, 6' privacy)
18. Are you aware of the need for heart worm prevention? *
  • Yes
  • No
19. Please list breed and ages of current pets:
20. Are current pets spayed/neutered?
21. Are pets current on vaccinations?
22. Are pets current on heart worm preventative?
23. Name and contact for veterinarian? *
24. Are you aware that adjustment periods can take up to two months? *
  • Yes
  • No
25. Are you aware that pets can have behavior problems? *
  • Yes
  • No
26. Do you have the time, responsibility and resources to give proper care and guidance to ensure a happy and healthy pet for its lifetime? *
  • Yes
  • No
27. Are you willing to submit to a representative from AGD doing a home visit prior to finalization of adoption? *
  • Yes
  • No
28. Personal reference #1. Name, phone contact and relationship to you: *
29. Personal reference #2. Name, phone contact and relationship to you: *
30. Signature of Applicant: *