Dog Adoption Application

Note: You can save your progress and return later by using the link at the bottom of the page.

Today's Date*
MM slash DD slash YYYY

Name*
First Last

Phone*

DOB*

Email*

Physical Address*
Street Address Address Line 2 City State ZIP Code

Is your mailing address different than above?*

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

I am interested in a*

Name of the pet you are interested in.*
Pet Name

Would this be your first pet?*

Do you have professional dog training experience?*

On a scale of 1-10, what is your comfort level with 'reactive' dogs?*
Please enter a number from 1 to 10.

Are you open to working with one of our trainers?*

Do you have any experience with 'special needs' dogs?*

Do you currently own a pet?*

What Kind?*

How Many?*
Please enter a number from 1 to 10.

Name of current animal and breed*
Pet Name Breed

Approximate Date you got your current pet.*
MM slash DD slash YYYY

Inside or Outside?*

Spayed or Neutered?*

Current on Vaccinations?*

Name of current animal and breed (2nd pet)*
Pet Name Breed

Approximate Date you got your current pet.*
MM slash DD slash YYYY

Inside or Outside?*

Spayed or Neutered?*

Current on Vaccinations?*

Name of current animal and breed (3rd pet)*
Pet Name Breed

Approximate Date you got your current pet.*
MM slash DD slash YYYY

Inside or Outside?*

Spayed or Neutered?*

Current on Vaccinations?*

Name of current animal and breed (4th Pet)*
Pet Name Breed

Approximate Date you got your current pet.*
MM slash DD slash YYYY

Inside or Outside?*

Spayed or Neutered?*

Current on Vaccinations?*

List any other pets you have (5th or greater)*
Please include all previously requested information.

Have you owned any animals in the last 10 years that you no longer own?*

How Many?*
Please enter a number from 0 to 10.

List names and breeds here

How long did you have this (these) pet(s)? List date(s) no longer in ownership or passing of pet.*

What Happened?*

Have you ever surrendered a pet to a shelter/rescue?*

Please explain why.*

Are there any other people in your household other than yourself?*
If Yes we need you to list name, age and relationship of everyone in the home Including Children

How Many? (Including Children)*
Please enter a number from 1 to 11.

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Name*
First Last

Age*

Relationship*

Do you live in a House, Apartment, or Condo?*

Do You Rent or Own?*

Name of your landlord
First Last

Phone number of your landlord

Is someone home during the day?*

Do you have a back yard?*

Is your backyard fenced?*

Other? Describe.*

Where will the animal stay when no one is home?*

Where will the dog sleep at night?*

What are your thoughts on a dog living indoors?*

What are your thoughts on a dog living outdoors?*

Will your cat be an 'outdoor' cat? (Allowed to come in and out at request?)*

What will their time outside look like? Hours? Free roam?*

What are your thoughts on an 'outdoor' cat?*

Are your current dog(s) on heart worm prevention?*

Vet Information
Vet Office Name Vet First Name Vet Last Name

Vet Phone Number

Name vet records are under
First Last

Do you consent to give UAAC access to your veterinarian records?*

You must contact your vet and let them know you give UAAC consent to release vet records to us.*
Understood

If you are approved for adoption, are you willing to follow proper introductions if you currently have pets in your home?*

Are you active duty military?*

Is there a chance of deployment?*

If deployed where will your pets go?*

If you should become unable to care for this animal, it must be returned to UAAC. It can not be given away to anyone.*
I agree

I am the interested potential adoptive party. I verify that I am at least 18 years of age. My personal identification is consistent with my age and address. I can show proof of housing. I can show proof that I am allowed an animal at my place of residence. Where applicable, all verifiable ESA paperwork will be presented at the time of the animal meet and greet. I understand that any deviation can result in a denied application.*
I agree

Signature*

Type full name

Thank you for choosing adoption. Completion of this application does NOT guarantee adoption. The adoption team will process your application and be in contact with you within 72 hours. Please allow for extended time if a weekend or holiday. Thank you for your patience.

Email
This field is for validation purposes and should be left unchanged.

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