Nala is a Mountain Cur. Very Elegant Adoption Form Please enable JavaScript in your browser to complete this form.Name *FirstLastDateBreed/Age Or enter name of or description of the animal you are interested in adopting,Home Phone *Work PhoneAge of applicant *Email *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you live in. *House TownHouseApartment CondoDuplex MobileDo youRentOwnOtherHow long at this address? *Do you live with your parents ?NoNoYes** YOU MUST PROVIDE THE NAME AND PHONE NUMBER OF YOUR LANDLORD OR CONDO ASSOC. WITHIN 24 HOURS OR WE WILL MOVE ON TO THE NEXT APPLICANT.Landlord's nameLandlord's PhoneApplicant's Employer *How Long Employed? *Does anyone in your home have allergies to animals?NoNoYesDoes anyone have asthma?NoNoYesDo you have a TOTALLY fenced in yard?NoNoYesSize of your yard:Type of Fence:Height of Fence:Where will the pet be kept during the DAY?InsideInsideOutsideOtherWhere will pet be kept during the NIGHT?InsideInsideOutsideOtherIf the Answer above is "INDOORS" where during the day and night?INSIDE - DAY(ie: Garage, Bedroom, Run of the House, Finished basement, Unfinished Basement, etc.) INSIDE - NIGHT(ie: Garage, Bedroom, Run of the House, Fnished basement, Unfinished Basement, etc.) During Routine Absences(ie: errands, work) Do you have aPET DOORDOG HOUSECRATEKENNEL RUNTIE-OUT STAKEOTHERHow many ADULTS live in your home?How many CHILDREN live in your home?Ages of children living in your homeDo children frequently visit & if so , what are their agesIs anyone home during the day? how long?, Who?Can they handle the animal you want to adopt?NoNoYesUnsureALL MEMBERS OF THE HOUSEHOLD, INCLUDING PETS, MUST VISIT WITH THE ANIMAL BEFORE THE ADOPTION IS APPROVED.How many hours will the pet be without humans each day? Who will be the primary care giver?Who will care for your animal while you are on vacation?What will you do with animal if you move?Are you willing and able to provide pet care for the next 10 or more years, including vet checks, vaccinations, boarding, medical care, indoor housing etc.?NoNoYesUnsureWhat do you think pet care costs per year, including annual vaccinations, food, toys, minimal ordering, grooming, etc.?Are you willing and able to support a pet?NoNoYesUnsureWe require all animals adopted fromus to be spayed or neutered. Do you have any questions or reservations about this policy?NoNoYesUnsurePlease list all pets you have owned in the past 10 years. If none, then include pets owned in your childhood (clearly indicate between childhood pet & pet as an adult). Include any pets residing in your home but which you do not own.Owned Pet 1Breed / Gender / Age / Spayed Neuterd / What Happened to Pet Owned Pet 2Breed / Gender / Age / Spayed Neuterd / What Happened to Pet Owned Pet 3Breed / Gender / Age / Spayed Neuterd / What Happened to Pet Owned Pet 4Breed / Gender / Age / Spayed Neuterd / What Happened to Pet Owned Pet 5Breed / Gender / Age / Spayed Neuterd / What Happened to Pet How long did you own the above listed pets?If deceased, how old was your pet when it died and explain details of death.If you have ever had a pet lost, disappear or die at an early age, please provide details dogs dying before 10 or cats before 14 years of age:Have you ever sold, given away or surrendered a pet? (explain)How do you plan to exercise your dog?Who will supervise outdoor activites?How will the dog be confined outdoors during exercise?Have you ever trained a dog?YesYesNoHave you ever Crate-trained a dog?YesYesNoAre you willing to give this pet time to adapt to it's new environment and family members?YesYesNoSOME PETS MAY TAKE 30 DAYS OR LONGER TO ADJUST.This animal may not be housebroken. Are you willing to take the time to work with animal?YesYesNoUnder what circumstance(s) would you surrender this pet?Past Veterinarian's name: *FirstLastPast Veterinarian's phone number:Name of pets treated:Intended Veterinarian:How did you hear about us / Who referred you?A rescue Representative will conduct a formal interview with you and your family prior to adoption.This interview is to answer any questions about your new pet and to alert you to problems that may arise.The rep will help you plan how to successfully introduce your new pet to your new home and to explain how to help your new pet become part of the family.I certify that I have answered all questions honestly and to the best of my ability. I understand that any misrepresentations of fact may result in removal of adopted pet from my home. *YesElectronic signatureClear SignatureDateCaptcha * What is 7+4? Submit Form
