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Vom Blue Adoption Application
Please answer all questions so we can properly review your application.
Name
*
First
Last
Age
*
Email
Spouse Name
First
Last
Age
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone
*
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Cell Phone
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Employer and Employer phone:
Reference Information:
Vet Name and Phone
If you do not have a veterinarian, you will be asked to provide the name and phone number to one prior to being approved for adoption.
Date of last visit
MM
/
DD
/
YYYY
When providing personal references, please include at least two which are not related to you.
Ref 1 name :
*
First
Last
Ref 1 Phone:
*
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Ref 2 Name:
First
Last
Ref 2 Phone:
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Ref 3 Name:
First
Last
Ref 3 Phone:
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Environment
Number and Ages of Children
Please list the names and ages of anyone else living in your home that are not listed above:
Is everyone in your home in agreement to adopt a dog ?
Please select
Yes
No
How long have you lived at this address?
Describe your current living situation:
Please select
House
Apartment
Mobile Home
Condo
Do you:
Please select
Own
Rent
Live with Parents
Landlords Phone
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If renting please provide
What type of environment ?
Please select
City
Country
Suburban
Fence ?
*
Please select
Yes
No
What type and how tall:
Where will the dog be kept while you are not at home ?
Adoption Information:
Why do you want a dog ?
*
Breed Preference
Age Preference
Sex Preference
If interested in a specific dog, please list their name here
Please list all current pets
Name
Breed
Age
Sex
Please list all current animals, please also note if they are Spayed/Neutered, Vaccinated, and if kept on prevention.
Please list the pets you've owned in the past 3 years who are not listed above and what happened to them and why ?
( Ex. Fluffy , Poodle Female , Passed away at age 10 , old age )
Do you understand that all dogs adopted from Vom Blue are to be returned to Vom Blue if the adoption does not work out ?
*
Please select
Yes
No
All adoption fees are non-refundable and will be considered a donation to the rescue.
Certification:
Please read the following very carefully . By signing this adoption application you hereby certify that all the above information is true and correct and agree to the following terms to be considered for adoption of a rescue dog:I understand that the previous history and/or heritage of any particular dog is unknown prior to them being accepted into foster care by Vom Blue Rescue .
I understand that providing any false or misguiding information on this application will result in immediate denial of my application . I understand that all animals placed by Vom Blue will be altered prior to adoption, and will not ask Vom Blue to deviate from this mandatory policy .
I understand that if i am approved for adoption ,that although i may state a preference that the final decision as to what dog i will be allowed to adopt is that of Vom Blue Rescue and i agree to adhere to their advice.I understand that Vom Blue Rescue in under NO obligation to approve my application and reserves the right to deny any application without any cause or reason .
I am 18 years of age or older , emotionally and financially capable of caring for, training, and providing a stable enviroment for a rescued dog. I will supply all medical care and every other needs to meet the well-being of this pet. And i will provide proof of Vet care to Vom Blue if required at any time. If adopted dog is not being vetted and/or treated properly , Vom Blue reserves the right to take back the adopted dog
Name and Date
*
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