EmailMe Form - Treat Em Right Adoption Application

Name *

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Cell Phone Number

### - ### - ####

Home Phone Number

### - ### - ####

Employer

Work Number

### - ### - ####

Email Address *

Co-Applicant Name

First Last

Co-Applicant Cell Number

### - ### - ####

Co-Applicant Work Number

### - ### - ####

Are you....... *

Do you have children\grandchildren *

Yes

No

How many family members/roommates/people living in your home? *

List ALL names and ages of family members and people living in the home

Are all members of the household agreeable to the adoption? *

Yes

No

Who will be primarily responsible for the care and well-being of the dog? *

Have you previously owned a dog? *

Yes

No

What happened to him/her

If you have ever turned in an animal, please explain the reason why.

What happened to him/her

Will you attend training classes? *

Yes

No

Please explain your answer for attending training classes.

What would you consider a major medical expense that you could not afford. *

0 - $250.00

$250.00 - $500.00

$500.00 - $1000.00

more than $1000.00

What traits are you looking for in a dog?

Do you want an inside dog, outside or both? *

Do you have a secure fenced yard or kennel? Electric fencing in not permitted. *

Yes

No

Please describe your fence..

If you do not have a fence, how do you plan on keeping him/her exercised?

Where will your dog sleep at night? *

Do you rent or own your home? *

If you rent, landlord's name, address and phone (required for renters)

Do you currently own any pets? *

Yes

No

Please list all your current pets. Include their age, breed, male or female.

Are all of your current pets spayed/neutered?

Yes

No

Are all of your current pets current on vaccines?

Yes

No

Are all of your current pets on heartworm preventative?

Yes

No

Please list the veterinarian you use. Include address and phone number.

Under what circumstances would you consider getting rid of your dog?

Will someone be home during the day? If not, where will you keep the dog while you are gone?

Will you crate your dog while you are gone?

Yes

No

Reason for you answer for crating

Why do you want a dog?

If you have children or grandchildren in the future what will you do with the dog?

What dog are you interested in?

I certify that information contained in this application is true and complete. I agree to allow my veterinarian and landlord to release information to Treat Em Right representatives.

Initial *

Date *

MM / DD / YYYY

Please type your name here (signature)

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