Dog Adoption Application - Valley Animal Center

Dog's Name:*

Adopter's Name:*

First Last

Co-Adopter's Name:

First Last

Adopter's Phone*

Adopter's Email Address:*

Adopter's Address:*

Street Address Address Line 2 City State ZIP Code

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How long have you been at this address?*

Rent/Own?*

Name of Landlord/Manager:*

First Last

Landlord/Manager Address:*

Street Address Address Line 2 City State ZIP Code

Landlord/Manager Phone Number:*

Do you have a secure, fenced yard?*

How large is the yard?*

Where will you keep the dog?*

If you move, will you take the dog with you?*

Adopter's Employer:*

Other source of income:

Co-Adopter's Employer:

Other source of income:

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Is this pet for you?*

Who is the pet for?*

Have you ever had a pet?*

What kind of pet?*

Do you still have the pets?*

Why not?*

Are your pets spayed or neutered?*

Why not?*

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Do you have any known allergies to dogs?*

Please explain:*

Do you suffer from asthma?*

Please explain:*

Are you a frequent traveler?*

How often do you travel?*

Do you have children?*

What are their ages?*

Children may be scratched or bitten by a pet (especially a playful puppy). If you or a child receives a scratch or bite, will this be reason for you to return the animal to the shelter?*

Would normal wear and tear on household items be a reason to return this animal to the shelter?*

Veterinarian:

Phone:

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Are you financially able and willing to give the dog any medical care it may need?*

The life span of a dog may be up to 15 years. Are you prepared to care for this dog for its natural life?*

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Do you have someone who will care for the dog if you are unable to for any reason?*

Name:*

First Last

Phone Number:*

Address:*

Street Address Address Line 2 City State ZIP Code

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How did you hear about us?*

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The Adopter hereby understands and agrees that any and all fees charged for the adoption of this animal are non-refundable. The Adopter also understands and agrees that if any animal adopted from Valley Animal Center is not compatible in their household or does not work out for any reason, the animal may be returned within 30 days of the date of this contract. If the Adopter found that this animal was incompatible but would like to exchange him/her for another animal, the animal may be exchanged within 30 days of the contract, pending approval. The Adopter understands that they are only allowed to make a one-time exchange.*

I have read and agree to the terms and conditions stated above.

After the 30-day period has expired, the Adopter may return the animal to Valley Animal Center only upon approval from the Animal Care Manager and with the requirement of a surrender fee, which will be determined by Valley Animal Center.*

I have read and agree to the terms and conditions stated above.

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Submitting a Dog Adoption Application does not guarantee the Adopter's application will be approved by a Valley Animal Center adoption counselor. After the Adopter's application has been thoroughly reviewed, an animal care associate will inform the Adopter if his/her application is approved or rejected.*

I understand.

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