Animal Aid Vermilion Area

Name

Street Address - include apartment number if applicable

City

State

Zip Code

Home Phone Number

Cell Phone Number

Email

Date of Birth/Age

Ages of others in your home

Name the dog you are interested in adopting. We recommend you list several dogs. If you do not have a specific dog in mind, please list preferred age, sex, and breed.

Who will have responsibility of taking care of the dog?

Please specify why you are interested in this dog.

Type of home you live in. (Mobile, Apartment, House)

How long have you lived there?

Landlord Contact Info - Name and Phone Number

Activity level of dog wanted/expected.

Please provide your current pets' name, breed, spayed/neutered, date of last vaccination. Please seperate animals with a comma.

Name: Breed: Male/Female: Age: Spayed/Neutered: Date of last vaccinations:

Are your dogs given monthly heart worm prevention? If yes, list the brand and where it is purchased.

Do any of your dogs have physical problems?

Do any of your current dogs have behavioral/dominance problems? Explain.

Please list your past pets and why they are no longer in your care.

Veterinarian-Name, Address, Phone Number. They will be contacted to verify information given. If no current veterinarian, please list past veterinarian.

Would you consider special needs animals?

Yes
No

Where will your dog spend its days? Nights?

Days: Nights:

Will the dog be allowed in the house? If no, please explain why.

How long will the dog be left alone during the day? Where will it be kept when you are gone?

Are you familiar with the use of a crate to train the pet during your absence or at night?

How do you plan on getting your new dog home?

Is your yard fenced? Give a description of your fence.

Do you plan on using a runner or a chain to exercise the dog or to contain the dog?

How much do you expect to spend on regular health maintenance for your dog in a year? (not including food)

Have you ever sold, surrendered, or given a dog away? If yes, explain why.

Do you, or anyone in your home, have any physical limitations?

If and when you move, what would you do with your dog?

In case you have to evacuate, where will your pets go?

What plans will you make for the dog during your vacation?

How long would will you commit to taking care of the dog? (ex. as long as it's young, as long as it's healthy, as long as it can hunt, until we have children, for the dog's entire life.)

What would you do if the pet becomes very ill? How far would you take treatment?

It can take months for your new pet to adjust to his/her new life. Which of the following would you NOT be willing to work through until your pet has become adjusted?

Shy and/or fearful
Chewing
Biting
Not getting along with others
Accidents in the house
Barking and/or whining

Please tell us a little of you and your family's lifestyle including any special activities in which your dog would be included.

Do you understand and accept that changing a dog's environment may cause the dog to have accidents, especially in the early days of adoptions?

What reasons would you consider giving up your dog?

Have you or any member of family/household has been cited for leash law violations or cruelty to animals in the past? If yes, please explain.

Reference #1-Name and Number - REQUIRED

Reference #2-Name and Number - REQUIRED

Have you read the adoption requirements as stated above this application?

Yes
No

Type your name here to verify that the information above is true and complete. The dog will reside in your home as a pet. You will provide it with quality dog food, plenty of fresh water, monthly heartworm prevention, indoor shelter, annual physical examination and vaccinations under the supervision of a licensed veterinarian, and unconditional love and affection.