Personal Information

Full Name:

Address:

City: State: Zip:

Phone(Daytime): Phone(Evening):

EMail:

References

Personal Reference Name:

Reference Phone:

Information on Home

Do you live in a:
House in the country
House in the city or a subdivision
Townhouse
Condo
Apartment
Trailer What Park?
Other

Do you own or rent?   Own   Rent

If renting, are pets allowed?   Yes     No

Is there a weight limit?   Yes     No If yes, what is the limit?  

Landlord's Name(if renting):  

Landlord's Phone:  

Do you have a fenced yard?   Yes     No

If yes, what type?   What height?  

What is the size of the yard?  

If not fenced, how do you propose to handle the dog's exercise and toilet duties?

Do you have a seperate kennel run?   Yes     No

Do you have a doggie door?   Yes     No

Family Situation

How many adults in the home?  

How many children?   Children(s) ages?  

Are any members of your household home during the day?   Yes     No

Do you have other dogs?   Yes     No If yes, how many?  

Are they spayed/neutered?   Yes     No

Do you have cats?   Yes     No If yes, how many?  

Are they spayed/neutered?   Yes     No

Veterinarian   (If you have or had other pets)

Who is your regular veterinarian?  

Veterinarian's phone:  

Approximate date of last visit:  

Were/are your animals current on vaccinations?   Yes     No

Previous Pets

How many dogs have you owned in the last five years?  

What happened to them?  (Lost, stolen, given away, etc.)

If any died, list age and cause:

Pet You Wish to Adopt

Type of puppy/dog you are looking for?  

Gender prefer:   Male     Female     No Preference

Of the current puppies/dogs available for adoption, please list in
order of preference. Please keep in mind that it is possible that
your 1st, 2nd, and/or 3rd choices could already be spoken for.

1st:

2nd:

3rd:

What are your plans for the dog?  
(pet, guard, hunting, etc.)

Where will the dog spend most of the day?  

Loose indoors In a gage In basement In garage		Fenced yard Loose outdoors Tied up outdoors Other
List Other:

Where will the dog spend most of the night?  

Loose indoors In a gage In basement In garage		Fenced yard Loose outdoors Tied up outdoors Other
List Other:

What is your definition of disciplining a dog?

Note: By submitting this Adoption Application, you are testifing that it is true and factual. West Michigan SPCA reserves the right to reject any applicant for any reason at any time.