Save A Dog
Save A Dog
Adoption Application
You must be 21 years old and have a valid driver's license or picture ID to be to adopt.
Date: ___________________
SECTION 1: PERSONAL INFORMATION
First Name: ________________________ Last Name: ___________________________
Address: _______________________________________________________________
_______________________________________________________________________
City: _______________________________ State: _________ Zip+4: ______________
Home Phone: ( ) ___________ Cell Phone: ( ) ____________
E-mail Address: __________________________________________________________
(required to be notified of dogs available) (PLEASE PRINT CLEARLY)
Occupation: _____________________________________________________________
Dog Interested in: _____________________________________________________________
Have you applied with other dog adoption agencies? If so, let us know if the home visit is complete. ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
SECTION 2: DOG INFORMATION
Is this application for one or more of our currently available dogs? Yes _____ No _____
If Yes, Please list the names of the dog or dogs for which you are applying:
_________________________________________________________________________
If No, please let us know what type of dog you are looking for. If you have a preference as to
sex and size, please indicate that also.
__________________________________________________________________________
__________________________________________________________________________
What is the OLDEST age dog you will accept? : ________
Any age is acceptable: _____
Will you accept a dog that has treatable medical problems, i.e., needs pills? Yes ____ No ___
Maybe ______ with the following conditions
__________________________________________________________________________
SECTION 3: ENVIRONMENT FOR DOG
Do you have a completely fenced-in back yard on your property? Yes ___ No ___
If you have no fence, how do you plan to have your new dog receive proper exercise?
________________________________________________________________________
Do all adults work full time? Yes ___No ___ Opposite hours ___ Flex hours?____Work from home___
How many total hours each day will your new dog be alone? _____ Hours
How will you structure the dog’s time when s/he is alone? Will you use a dog walker or daycare? Please provide name of dog walker or daycare.
________________________________________________________________________
________________________________________________________________________
Will you be feeding dry kibble and if so, what brand; If a raw diet please indicate so.
________________________________________________________________________
Are you aware that certain pet food companies put euthanized pets and road kill in their food? Are you willing to take our recommendations on dog foods that are safe?
________________________________________________________________________
Obedience training is mandatory for our adopted dogs. Do you have a trainer lined up? If not, do you need a referral?
________________________________________________________________________
Are there any medical conditions or mental or emotional issues that might prevent you or your family members from caring for a dog on a permanent basis? If so, please explain.
________________________________________________________________________
SECTION 4: REFERENCES
Please provide the contact information of a veterinarian you have used before and plan to use with your new dog? Vet references are checked.
Vet Name: __________________________________ Vet Phone:( )_________
Vet records are under the name of: ________________________________________
Please provide at least two personal references, preferably your dog trainer, pet sitter, groomer or someone who knew your previous dogs, or if you’re a first time dog owner, the name of someone whose dog you have cared for. Include their name, telephone # and how this person knows you and your ability to provide a good home for a dog:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
SECTION 5: HOUSEHOLD INFORMATION
Please list place of employment for yourself and your spouse, if applicable. Include the location of each employer.
My Employer is: ______________________________________________________
Spouse’s Name: ______________________________________________________
Spouse’s Employer: ___________________________________________________
Residence: Own _____ Rent _____
Please note: If you own, proof of ownership will be required for the adoption process.
If you rent, you must provide your landlord's contact information below so that we may verify that you are allowed to have a pet.
Landlord’s Name, Address, Phone Number: _____________________________________________________
______________________________________________________
Total number of people living in your residence (including yourself): __________
Do you have 1 or more cats? : Yes _____ No _____
List below all people who currently live at this residence, including yourself (children’s names not required, you can put daughter/son/grandchild):
Household Member Relation to you Age
________________ ________________________________ ____________
________________ ________________________________ ____________
________________ ________________________________ ____________
________________ ________________________________ ____________
________________ ________________________________ ____________
Does anyone in your house have any known allergies to dogs? Yes ___ No ___
List below any cats, dogs, etc. who currently lives in your household:
How long Kept
Name Type/Breed Age? Sex/Neutered? Owned? Where?
_____________ ________________ ____ ____________ _________ ___________
_____________ ________________ ____ ____________ _________ ___________
_____________ ________________ ____ ____________ _________ ___________
_____________ ________________ ____ ____________ _________ ___________
SECTION 6: HISTORY
Have you owned a dog before? : Yes ______ No ______
If yes, please provide a brief history of what happened to it. If your last dog died, please state dog's name and date deceased.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
SECTION 7: DONATION INFORMATION
The adoption donation ranges from $350-425 for adult dogs and $450-550 for puppies. This cost is to cover increasing transportation costs and extra health certificates for our dogs. Out of state dogs receive a medical exam and health certificate prior to transport and also after the 48 hour state-mandated quarantine. Are these terms acceptable?
Yes _____ No _____
Please realize that dogs need vet care throughout their lives. If you cannot afford this donation, you may not be able to afford the appropriate vet care. Please consider this before adopting a dog.
Are these terms acceptable to you? If so, please indicate by signing below:
I certify that I have read the above Adoption Application and donation information and will execute same promptly upon receipt. All medical records and other pertinent information will be provided to you upon receipt of above.
Signature: _____________________________________________________________
Print name: ____________________________________________________ Date ___________
Please return this application by email to adoptions@ or fax our toll-free fax number, 877-349-9254 or mail to:
Save A Dog
604 Boston Post Road
Sudbury, MA 01776
If you have any questions, please call: Save A Dog at (978) 443-7282.
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