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. Street Address: *
5. City: *
6. State: *
7. Zip Code: *
8. Phone Number: *
9. Email: *
10. Employer: *
11. Do you rent? *
  • Yes
  • No
12. Is there a pet policy?
  • Yes
  • No
13. Name & Contact for Landlord:
14. Children in the home? Please list ages if yes. *
15. Is anyone home during the day? *
  • Yes
  • No
16. How many hours daily will the pet be left alone? *
17. Where will pet be when no one is at home? *
18. Is shelter provided for outside? *
19. Do you have a fenced yard? *
  • Yes
  • No
20. If yes, what type and height of fence? (i.e. 4' chain link, 6' privacy)
21. Are you aware of the need for heart worm prevention? *
  • Yes
  • No
22. Please list breed and ages of current pets: *
23. Are current pets spayed/neutered? *
24. Are pets current on vaccinations?
25. Are pets current on heart worm preventative?
26. Name and contact for veterinarian? *
27. Are you aware that adjustment periods can take up to two months? *
  • Yes
  • No
28. Are you aware that pets can have behavior problems? *
  • Yes
  • No
29. 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
30. Are you willing to submit to a representative from AGD doing a home visit prior to finalization of adoption? *
  • Yes
  • No
31. Personal reference #1. Name, phone contact and relationship to you: *
32. Personal reference #2. Name, phone contact and relationship to you: *
33. Signature of Applicant: *