Puppy and Dog Adoption Application

Is there a certain pet you are wanting to adopt?

Please type the name of the pet above

Why do you want to adopt?(Required)

Companionship

A companion for my other dog

Watch Dog/Protection

Gift for someone else

A pet for my child

Contact Information

Name(Required)

First Last

Maiden name or aliases

Date of Birth(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

How long have you resided at your current address?(Required)

Occupation(Required)

Family and Housing

How many adults are in the home?(Required)

Adult #2(Required)

First Last

Adult #2 Date of Birth(Required)

Adult #3(Required)

First Last

Adult #3 Date of Birth(Required)

Adult #4(Required)

First Last

Adult #4 Date of Birth(Required)

Adult #5(Required)

First Last

Adult #5 Date of Birth(Required)

How many children live in the household or visit regularly?(Required)

List the age of each child.(Required)

Have you or anyone in your household ever been convicted of a violent crime?(Such as, but not limited to: battery, assault, domestic abuse, child abuse/neglect, animal abuse/neglect, etc)(Required)

Please describe your convictions. Include dates, county, and state.(Required)

What best describes the type of home you live in?(Required)

How active is your household?(Required)

There are no wrong answers, so please answer honestly. Different dogs have different activity needs. This information allows us to help pair you with a dog that best fits your lifestyle.

Please describe your household:(Required)

Do you rent or own your home?(Required)

*We do verify home ownership. If you do not own your home, please select RENT. We will need to speak with the homeowner or landlord to ensure the a new pet is allowed.

Landlord's Information(Required)

Landlord’s Full Name Landlord’s Phone Number

If you rent, please provide your landlord’s name and Phone Number. By providing this information you are giving Northwoods Animal Alliance permission to contact your landlord. Please inform them of this call so they will speak with us.

Does anyone in the family have a known allergy to dogs?(Required)

Is everyone in agreement with the decision to adopt a dog?(Required)

Do you feel you have time to provide adequate love and attention based on the dog's needs?(Required)

Other Pets

Do you currently have any other pets?(Required)

Please provide information for each pet. Including type, breed, and age.(Required)

Have you had any other pets in the past?(Required)

Please list any previous pets and why you no longer have them?(Required)

Are your current pets up to date on vaccines?(Required)

Are your current pets spayed/neutered?(Required)

If not Spayed/Neutered, please explain why.(Required)

Have you ever surrendered a pet?(Required)

If you surrendered a pet, please explain why.(Required)

What do you consider an acceptable reason for giving up a pet?(Required)

Have you ever lost a pet to an accident?(Required)

Please explain any accidents that resulted in the loss of a pet.(Required)

How would you correct a dog’s unwanted behavior?( EX: If they are chewing on furniture or having accidents in the house)(Required)

What brand of dog food have you used for your present or previous pets?(Required)

Veterinarian

Do you have a regular veterinarian?(Required)

(Providing this information you are allowing NWAA to call your vet. Please call your vet and ask them to authorize the release of information to Northwoods Animal Alliance.)

Who is your veterinarian?(Required)

Clinic Name:(Required)

Veterinarian's Address

Street Address City State ZIP Code

Veterinarian's Phone(Required)

Who is the responsible person's name on the veterinarian account:(Required)

***** PLEASE CALL YOUR VET TO RELEASE YOUR RECORDS to Northwoods Animal Alliance. Without a records release we cannot process your application. **** Please tell us who’s name, first and last, is on the account so that we can call and verify.

About the Dog You Wish to Adopt

What is your idea of an ideal dog and why?

Desired Sex:(Required)

Desired Age(Required)

Desired Breed(Required)

Breed you would NOT adopt and why:(Required)

Desired Size:(Required)

Extra Small (under 15 lbs)

Small (15-30 lbs)

Medium (30-50 lbs)

Large (50-80 lbs)

Extra Large (over 80 lbs)

Willing to adopt:(Required)

Outgoing/high energy dog

Shy dog

Dog that needs regular medication

Dog that needs training

Dog that requires regular grooming

None of these

What are your plans regarding training and obedience?(Required)

Where will the dog spend the day? (describe)(Required)

Where will the dog spend the night? (describe)(Required)

Number of hours (average) dog will spend alone per week?(Required)

Who will have primary responsibility for this dog's daily care?(Required)

Who will have financial responsibility for this dog?(Required)

How much money do you expect to spend on care for your dog per year? INCLUDING food, vet care, supplements, toys, grooming etc.(Required)

Do you understand that your new pet will likely require to be house trained? How do you plan to house train?(Required)

Do you agree to provide regular health care by a Licensed Veterinarian?(Required)

Do you agree to keep the dog as an indoor pet only? Meaning the dog will primarily live indoors as a member of the family and not kept oudoors without supervision?(Required)

When the dog goes out, how do you plan to supervise it? Fenced yard? Kennel? Dog Run? Leash?(Required)

Do you plan on crating your dog?(Required)

Do you agree to contact Northwoods Animal Alliance if you can no longer keep this dog?(Required)

Are you willing to let a representative of Northwoods Animal Alliance visit your home by appointment?(Required)

Two Personal References – Not a relative

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Relationship to reference:(Required)

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Relationship to Reference(Required)

Agreement

** NWAA reserves the right to refuse any adoption application. ** Animals are not placed on a “first come first served” basis. Placement is based on the best fit for the animal. **All of the information I have given is true, complete and not misleading. ** This dog will reside in my home as a pet. I will provide it with quality pet food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. ** Selecting YES and providing your name below you agree to this statement.

I agree(Required)

Yes

Name(Required)

First Last