Dog Adoption Form

The information you provide in this application will help us to ensure you and your future dog are a perfect match.

Full Name *

Phone Number *

Address *

City *

Province *

Postal Code *

Email *

ADOPTION CANDIDATE INFORMATION

Name of the dog you would like to adopt

Why have you chosen this particular dog?

Why do you want to adopt a dog? *

Please explain your experience with dogs. *

HOUSEHOLD INFORMATION

What type of dwelling do you live in? *

Do you rent or own your home? *

How long have you lived at your current address? *

Is any member of your household allergic to dogs? *

Yes
No

Please list all members of your household, ages and genders:

Who will be primarily responsible for caring for the dog? *

Will this dog be mainly indoor or outdoor? *

Where will the dog be primarily kept? *

Where will the dog sleep? *

How often will you exercise the dog? *

Do you have a fenced-in yard? *

Yes
No

Do you have other pets? *

Yes
No

Southampton Pet Hospital strives to place dogs in the perfect home for their individual personalities and needs. To help us with this process we ask that you provide us with 3 references. Each reference will be called prior to approval of adoption and each will be asked a set list of questions. To accelerate this process, please advise your references ahead of time that we may be contacting them.

Please provide at least 2 personal references and 1 professional reference of someone you have known for at least 2 years and is not related to you.

Information provided in this completed application may be shared with other staff members at the Southampton Pet Hospital, in an effort to make the best decision regarding the possible adoption of a dog. Your personal information will be kept confidential. The submission of this application does not confirm the adoption of this dog.

Vet care provided prior to adoption does not guarantee future health of this dog. Should you adopt this dog, his/her care is fully your responsibility. Please be advised that the dogs available for adoption are stray dogs, and their origins are unknown. The adoption fee for a dog is $350.00. This fee is to be paid in full should you be accepted to adopt this dog. Adoption fees go entirely towards the necessary veterinary care prior to the adoption of this dog, and supports the care of both current and future strays.

I have read, understand, and acknowledge the above information provided to me by Southampton Pet Hospital. I claim all of the information that I have provided for this application to be true. *

Signature of applicant *

Date *

Today

Please verify that you are human *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

	Name	Relationship to applicant	Email	Phone #
Reference 1:
Reference 2:
Reference 3:

Dog Adoption Form

CONTACT INFORMATION

ADOPTION CANDIDATE INFORMATION

HOUSEHOLD INFORMATION

REFERENCES

TERMS AND CONDITIONS

Dog Adoption Form

CONTACT INFORMATION

ADOPTION CANDIDATE INFORMATION

HOUSEHOLD INFORMATION

REFERENCES

TERMS AND CONDITIONS

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