I am interested in adopting a: Dog Puppy
Preferred Age Range: ---8 weeks - 6 monthsTeenager/Young Adult (6 months - 5 years)Middle Age (6-10 Years)Doesn’t Matter
Please describe any specific characteristics you are looking for in a dog (such as: breed or mix, long hair/short hair, coloring, high/low energy level, good with children, good with other animals, etc.)
How did you hear about Caring For Creatures?---WebsiteFriendRadioNewspaperPetfinderOtherIf Other, please explain
Home Phone:Cell Phone (if different than home):
Are you at least 18 years of age? yes no(Adopters must be at least 18 years of age to be considered legal adopter and execute an Adoption Contract.)
Do you Own RentMy home is a:---HouseApartmentCondoLive with parentsOtherIf Other, please explain
How long have you been at this address:
Do you have your landlord’s/condo’s permission to own a dog? yes noIs there a size limitation?
Landlord's name:Phone No.:
How many adults in your household?:Children?:Provide Ages:
Are you planning to move in the next six months? yes noWould your dog go with you if you moved? yes no
Are family members aware that you are considering adopting a dog? yes no
If your family dynamics changed (marriage, divorce, new baby), would you keep your dog? yes no
If an allergy developed, are you willing to take steps to keep your dog? yes no
Do you have a yard? yes noIf yes, is it fenced? yes noIf yes, note the approximate size of fenced area, height of fence, and type of fencing:If no, how do you intend to exercise your dog and send him/her out for potty breaks?
Our Adoption Agreement provides that a dog will not be chained or tied outdoors, nor left outdoors for long periods unsupervised. Do you agree to these conditions? Yes No
Where will your dog sleep?
Where will you keep your dog while you are not home?
Approximately how long would you expect your dog to be alone each day?
Are you familiar with crate training? yes noIf no, would you be willing to learn more about it and consider the use of a crate as a training & transitional aid? yes no
How would you describe your household activity level:---very quiet & easygoingActive - usually something going onA 3-ring circus! People coming & going all day
How many dogs have you owned in the past ten years?Please list each dogs’ name, breed, sex,and age. If you no longer have the animal, what became of it?
Do you have cats? yes noIf yes, how many and what are their ages:
Are your existing animal companions spayed/neutered? yes no
Have you ever bred dogs? yes noHave you ever trained dogs before? yes noIf yes, what commands were taught?
Do you currently have a veterinarian? yes noIf yes, please provide vet’s name, location, and phone number, if available:
Have you ever been accused or convicted of animal neglect, abuse, or cruelty? yes no
Please add any other information you think would assist us in helping you select the best dog for you and your lifestyle:
Caring For Creatures
352 Sanctuary Lane, Palmyra, VA 22963
(434) 842-2404 Fax: (434) 842-1308
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