Puppy and Dog Adoption Application Puppy and Dog Adoption Application Is there a certain pet you are wanting to adopt? Please type the name of the pet aboveWhy 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 InformationName(Required) First Last Maiden name or aliases Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address(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 HousingHow many adults are in the home?(Required)Select OneJust MeTwoThreeFourFive or moreAdult #2(Required) First Last Adult #2 Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult #3(Required) First Last Adult #3 Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult #4(Required) First Last Adult #4 Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult #5(Required) First Last Adult #5 Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920How many children live in the household or visit regularly?(Required)Select OneNo children are regularly in the homeOneTwoThreeFourFiveSix or moreList the age of each child.(Required) Add RemoveHave 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)YesNoPlease describe your convictions. Include dates, county, and state.(Required) Add RemoveWhat best describes the type of home you live in?(Required)Select OneSingle Family HomeDuplexApartmentFarm, Ranch, or Hobby FarmRented RoomDormHow active is your household?(Required)Select OneCompetitive/Working (Agility, Rally, Schutzhund, etc)Very Active (Hiking, Skijourning, Running, etc)Average (Daily Walks, Enrichment, and Training)Relaxed (Leisurely Strolls, Playing in the Yard, etc)Very Relaxed (Couch Potato, Minimal Routine Activities)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)Select OneBusyNoisyQuietAverageDo you rent or own your home?(Required)OwnRent*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)Select OneNoYesIs everyone in agreement with the decision to adopt a dog?(Required)Select OneYesNoNot sureDo you feel you have time to provide adequate love and attention based on the dog's needs?(Required)Select OneYesNoOther PetsDo you currently have any other pets?(Required)Select OneYesNoPlease provide information for each pet. Including type, breed, and age.(Required) Add RemoveHave you had any other pets in the past?(Required)Select OneYesNoPlease list any previous pets and why you no longer have them?(Required) Add RemoveAre your current pets up to date on vaccines?(Required)Select OneYesNoAre your current pets spayed/neutered?(Required)Select OneYesNoIf not Spayed/Neutered, please explain why.(Required) Have you ever surrendered a pet?(Required)Select OneYesNoIf 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)Select OneYesNoPlease 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) VeterinarianDo you have a regular veterinarian?(Required)Select OneYesNoNo, but I had a regular vet in the past(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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 AdoptWhat is your idea of an ideal dog and why?Desired Sex:(Required)Select OneMaleFemaleNo PreferenceDesired 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)Select OneYesNoDo 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)Select OneYesNoWhen 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)Select OneNoNo, I think crates are cruelYes, I will be crate trainingYes, but only when I'm not homeYes, but only for house trainingYes, but only when the dog is naughtyUnsure, I'd like to learn more about crating.Do you agree to contact Northwoods Animal Alliance if you can no longer keep this dog?(Required)Select OneYesNoAre you willing to let a representative of Northwoods Animal Alliance visit your home by appointment?(Required)Select OneYesNoTwo Personal References – Not a relativeName(Required) First Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Relationship to reference:(Required) Name(Required) First Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 Δ