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