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?
*
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?
*
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