NameAddressCityStateZipHome PhoneCell PhoneOccupationEmployerEmployer AddressEmployer PhoneEmailAge of the Applicant:Over 21 but Under 2525-3535-4545-5555-6565-75Over 75If over 75, please list age1. How did you hear about our adoption program? If from a friend/relative, please name.2. Why do you want to adopt a dog?3. What other pets do you have now? Please list breed of dog, sex, age, and if spayed/neutered4. Approximately how many hours a day do you work outside the home? Please figure in commuting time.5. Are there children in the household?YesNoPlease list ages and sex:5a. Are there grandchildren/relatives or friends’ children who visit frequently?YesNo6. Dwelling TypeSingle FamilyTwo-FamilyMultiplue7. Do you own your own home:YesNo7a. If no, do you have landlord’s permission to have a dog? YesNoN/AIf yes, please list his/her name and phone number: 8. Do you have a fully fenced area attached to your home?YesNo8a. What type of fencing? 8b. What height?9. If not, is there a fenced area nearby where you can exercise your dog once or twice a week? YesNoN/A10 Where do you intend to house your dog? 11. How often are you willing to take your dog outside to relieve himself? 12. Do you intend to keep your dog on a leash when outdoors unless in a fenced area? YesNo13. Please provide us with the name, address and phone number of all veterinarians who know you or have treated your animals. Please list the name and type of animal and the years in your care. I hereby give my permission to release all veterinary information to a Make Peace With Animals Representative regarding the care I give my animal(s). I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. PDF Version of the Application: Download Application
