Please Note: All fields are required before submission of this form. Thank You.

Before you complete this application, please confirm that you are:

  • Parent or Head of Household
  • Age 21 or Older
  • Ready to adopt a dog NOW (We don't "hold" applications for future adoptions)

This Application must be completed by Adult Head of Household/Parent(s) only.
Please complete all questions and fields. If not applicable, please indicate.

Date

Dog's Name



About You


Your Name

Email Address

Address

City

State

Zip

Home Phone

Work Phone

Cell Phone

What kind of dog are you looking for?

What are your reasons for adopting a dog?

Who is the dog for?

Who will be primarily responsible for the dog's care?

Is it a gift?

How many people are living in your household?

What are their ages?

If anyone under age 18 is living with you, have they been around dogs before?

Does anyone in the household have allergies?

If Yes, please explain:

Have you ever owned a dog before?

If Yes, what happened to it?

What reasons would make you give up your dog?

Have you ever given up a dog before?

If Yes, please explain:

If your adopted dog develops behavior problems, how will you handle it?

Do you currently have pets?

If Yes, please specify breed, age, and sex:

Are they spayed / neutered?

Are they licensed?



Home Information


Type of dwelling

Rent or Own

If you Rent, do you have Landlord's permission?

Years at this residence:

Do you have a yard?

If Yes, is it fenced?

If Yes, how high is the fence and what type?

Do you have a patio?

If Yes, is it fenced?

If Yes, how high is the fence and what type?

Do you have a balcony?

If Yes, is it fenced?

If Yes, how high is the fence and what type?

Do you have a jacuzzi/spa or pool?

If Yes, is it fenced?

Where will your dog spend time while you're home?

Please explain:

Where will your dog be kept when no one is home?

Please explain:

How many hours will your dog be alone each day?

What type of outdoor shelter is currently available?

Where will the dog sleep at night?

Who cares for your dog when you vacation?

Are you aware that you will be paying an adoption fee for this dog?

In 2008, the annual cost for basic care (food, medical, supplies, grooming/flea treatment) was $800 to $1,500 a year, not including medical treatment for emergency health issues. Are you able and willing to pay these basic expenses PLUS any additional costs if your dog becomes sick or injured?

Please explain:

What veterinarian treated your last dog(s) or your current dog(s); please provide the phone number and city where vet is located:

Vet's Name:

Vet's Phone:

Vet's City:

Do you object to New Beginnings doing a home check prior to adoption of the dog or following placement in its new home?

How did you hear about New Beginnings for Animals?