Dog Name
*
First Name
*
Last Name
*
Co-Applicant's Name
*
Street Address
*
Apartment Number (if applicable)
*
City
*
State
*
Zip Code
*
Phone Number
*
Alternate Phone Number
*
Email Address
*
Date of Birth
*
Drivers License Number
*
How long have you lived at this address?
*
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you own, do you have an HOA that has pet restrictions?
*
Yes
No
Unsure
N/A
Do you own or rent your home?
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Own
Rent
Someone else owns the Home
Someone else rents the Home
If you rent, does your landlord and lease allow pets?
*
Yes
No
Unsure
N/A
Landlord name & contact info
*
Including yourself, how many people live in your household?
*
Please list the ages & relationship of those who live in your home.
*
Employment Status
*
Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
If you are employed, what is your current occupation & place of employment?
*
On average, how many hours per day will your pet be left alone?
*
Will this be your first pet?
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Yes
No
Do you own other pets at the current time?
*
No Yes
If yes, please list their names, breeds, and ages.
*
Are all of your pets spayed/neutered/fixed?
*
Yes
No
N/A
Are your pets current on their vaccinations?
*
Yes
no
n/a
Are you familiar with heartworm and heartworm prevention?
*
No Yes
Veterinarian's Name
*
Veterinarian's Address, City, State, and Zip Code
*
Veterinarian's Phone Number
*
Have you ever surrendered a pet?
*
No Yes
If yes, please explain?
*
Have you ever had a pet euthanized?
*
No Yes
If yes, please explain:
*
Please check the reason you plan to adopt a pet (select all that apply):
*
Companion for self/family member
Companionship for other pet
Gift
Guard Dog
Service Dog
Other
If you answered "other" above, please explain here:
*
Is everyone in your household aware that you are planning to adopt a pet?
*
Yes
No
N/A
Do you have a "back up" or "emergency" plan for your pet(s) if you are no longer able to permanently care for them due to circumstances beyond your control?
*
Does anyone in your household have allergies to dogs/cats?
*
Yes
No
Possibly
N/A
Do you have a completely fenced-in yard? If so, what kind of fence?
*
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
If you answered "other" above, please explain:
*
What types of training have you used/would you use with your new pet? (select all that apply)
*
Crate Training
Housebreaking
Clicker Training
Positive Reinforcement
Negative Reinforcement
Formal Obedience
Agility/Performance Training
I have never trained a dog before
How do your current pets/how would this pet access your yard? (please check all that apply)
*
Dog door, left open throughout the day
on cable/chain
on leash
dogs will always be kept outside
dogs will only be let outside supervised
I have no current pets or the pets I have stay indoors always
Please list any references you would like us to contact in regard to this adoption.
*
How did you find out about us?
*
Adopt a Pet
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other
Adoption Event
I/We understand that a meet-and-greet with all family members and other pets is required before a VOCAL dog is sent home.
*
No Yes
I/We understand that a home visit is required for all dog adoptions by VOCAL (unless otherwise stated) and the home visit will be scheduled with me/us after my/our application is approved.
*
No Yes
I would like to hear more about VOCAL's initiatives. Please add me to your email list.
*
No Yes
I/We have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians.
*
Yes
No
I understand that while VOCAL performs due diligence with every rescued animal, that any animal can be unpredictable and I agree to assume the risk to myself, family, and pets when meeting and interacting with this animal
*
Clear
I understand that while the rescue animals are handled daily, but as with most animals, they may react in an unpredictable way to sounds, sudden movements, certain people, or other animals that could result in injuries.
*
Clear
By this waiver, I/children, assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property.
*
Clear
I understand this includes, but is not limited to, observing, working with or interacting with the animals, using the facility and its equipment in any manner, and practicing and/or engaging in other related activities.
*
Clear