Adoption Application


Adoption Application -NCISN
Name of Applicant*:
Address*:
City*:
State*:
Zip code*:
How long have you lived at this address?*:
Phone*:
E-mail Address*:
Which dog are you interested in adopting?:
Do you have a fenced in yard? If so, please describe the height and type of fence and size of yard.:
If no fenced yard, what provisions are there to protect and control your dog during exercise and potty breaks?::
Will this be your first pet?:

What kind of pets do you currently have in your home? Please include breeds, ages. :
Are your pets spayed and neutered?:

Are your pets up to date on their shots?:

Where did you get your pets?:
Name and Phone number of current veterinarian. *:
Do you have children?:

If yes, please list ages of children.:
How many adults in the home? Please list names and ages. Are all members in favor of adopting a pet?:
Who will be the primary caregiver for this pet?::
List your last 3 pets and the reason they are no longer with you.::
Why have you chosen to adopt a pet? (check all that apply):







What characteristics do you desire in a pet?:








How long each day will your pet be left alone?:
Please describe any experience you have with obedience training or other training. :
Where will the pet be kept when you are not at home during the day? At night? When you are out of town?*:
Are you adopting for yourself or for someone else?*:
Describe in detail the kind of dog you are looking for::
Have you ever turned an animal into a shelter? Yes or No. If Yes, please explain.:
Does any member of your family have allergies to dogs?:
Do you own or rent?:

If you rent, may we contact your landlord? Please provide contact information.:
Your occupation:
Name and phone number of employer. How long have you been employed there?:
If your new puppy isn’t housebroken, What method will you use to train him/her?:
Do you have a dog door ?:

How much daily exercise will your dog receive?:
If you drive a pick up, would you allow the dog to ride in the bed of truck?:

What arrangements will you make for your pets in case of an emergency?:
If you move, Will you take the Dog with you? Yes or No. If No, please explain.:
Are you willing to care for and be responsible for the dog for the next 10 to 15 years?:

What provisions will you make for the dog should you become unable to care for him/her?:
How much are you willing to spend on medical bills for your dog?:



What would you do if the medical bills went over this ammount?:
Please provide two personal references. Include Name, Address, Phone Number, and Relationship:

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