Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Best time to call

Name of pet(s) that you're interested in meeting *

Age or Date of Birth *

I am interested in a: *

Puppy 0-6m
Young Dog 6 months-2years
Adult Dog 2-7
Senior Dog 7+

What type of home do you live in? (house, apartment, condo, townhome, etc.) *

Do you *

Live by rent
Own house
Live with parents
Other

Landlords Name and number - if applicable, please let them know we may be calling. *

If other, please specify *

Current Employment Information *

If other, please specify *

If employed, please list your employer, job title/line of work and length of time employed there *

If part time, please list your job title/line of work and length of time employed there *

How many adults live in your home? *

Age of children in the home *

Does anyone in the home have a known allergy to dogs or cats? *

Yes
No

Please describe your household *

Active
Noisy
Quiet
Average

My Yard - choose all that apply *

If other, please specify *

Current Veterinary Hospital Name & Number. Please call the ahead of time to let them know that it's ok to release information to Serenity Animal Hospital *

Please list your current & past pets: name, breed, age *

Are your pet(s) current on ALL vaccinations? (including DHLPCA, Rabies, Bordetella, Fecal Testing, Heartworm Test, and Canine Influenza) *

Yes
No

If no, please explain why *

Are your pet(s) spayed or neutered *

Yes
No

If no, please explain why *

Are your pets given heartworm preventative year round? *

Yes
No

If no, please explain why *

Are your pets given flea preventative year round? *

Yes
No

If no, please explain why *

If you have every relinquished custody of a pet before, please explain why: *

Which pet insurance company do you have?

I would be willing to adopt a: (select all that apply) *

Where will your dog spend most of the day? *

Number of hours (average) that the dog will be home alone? * *

Who will have primary responsibility for this pet's daily care? *

Who will have financial responsibility for this pet? *

What will happen to the pet if you go on vacation? *

If you move in the future, what will you do with the pet you are planning to adopt? *

Will you allow the dog on furniture/beds? *

Will the dog have run of the house? *

Are you aware that veterinary care could cost up to $600 per year, without any serious illness? *

Do you agree to provide regular, yearly health care by a licensed Veterinarian? *

Yes
No

Do you agree to keep this pet as an indoor dog? *

Yes
No

Do you agree to contact Serenity if you can no longer keep this pet? *

Yes
No

What is your preferred level of exercise with a dog? *

If other, please specify *

Do you plan to take your new dog to training? *

Yes
No

If no, please specify *

What will you do if the pet is destructive while left alone? *

When the dog goes outside, how do you plan to supervise it? *

What method will you use to discipline your dog? *

Personal References : please list the Name, Number & Relationship for 2 references *

What would cause you to return your potential dog to us in the future? check all that apply *

All of the information I have given is true and complete. This pet will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examinations, vaccinations, heartworm and flea preventative from a licensed Veterinarian. *

I agree

Signature *

Clear Signature

Owner's Date of Birth *

Date *

Dog Adoption Application

Dog Adoption Application

Request an Appointment

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Location

Contact Information

Hours