Dog application Dog Adoption Application

Name (required)

Street Address

City

State

ZIP Code

Home phone

Work phone

Employer

Cell phone

E-mail address
(required)
Please use an alternate email if you have a yahoo account (if possible). Yahoo delays our responses.

Age

Are you interested in any particular
dog(s)? If so, which one(s)?

Otherwise, describe in detail the type of dog you're looking for:

Will this be your first dog?

  Yes   No
What kind of pets have you had in the past?

Which of these do you still have? Include age, sex and breed.)

Have they been spayed or neutered?

  Yes   No   Don't know
Are they current on vaccinations?

  Yes   No   Don't know
What happened to the pets you no longer have?

Have you ever turned your dog in to a shelter?

  Yes   No
If yes, please explain:

Have you ever had a pet euthanized?

  Yes   No
If yes, please explain:

If you have pets, will they adjust to a new dog entering the house?

  Yes   No   Don't know
Why do you want this dog?

  Companion   Companion for other pet
  Hunting     Breeding   Protection
  Gift      Other
If other, please explain:

Where will the dog sleep? (basement? garage? kennel? bed in the house, etc).
Please be as specific as possible.

Will the dog be primarily an indoor dog (in the house), or outside/garage dog?

Does everyone living in your home know about and agree with your decision to adopt a dog?

  Yes   No
If not, why?

How many adults are in your household?

What are the adults' ages and relationship to you?

How many children?

Children's ages?

Does any member of your household have an allergy to dogs?

  Yes   No
Is someone home during the day?

  Yes   No
If yes, who?

How many hours each day will the dog be without human companionship?

Please explain:

Where do you live?

  House   Apartment   Condo
  Mobile home   Other
If other, please explain:

Do you own or rent your home?

  Own   Rent
If you rent, may we contact the owner to obtain permission for this dog to live in your home?

  Yes   No
Owner's name and phone number:

Do you have a completely fenced yard?

  Yes   No
If fenced, please describe type of fence and height:

Is there a gate?

  Yes   No
If there's no gate, please explain:

Do you have a dog door?

  Yes   No
Where will you keep the dog?

  In the house   Outdoors
  Free access both indoors and outdoors
  In fenced run   Other
If other, please explain:

Are there times when the dog will be tied up?

  Yes   No
If yes, when:

Would you be willing and able to exercise the dog on a regular basis?

  Yes   No
Exercise method:

Will you keep the dog up-to-date on vaccinations?

  Yes   No
Please give your veterinarian's name, address and phone number:

If you go away for a few days, or on a vacation, who will take care of the dog?

If you move, will you take the dog with you?

  Yes   No
Have you ever applied to Elmsford before to adopt an animal?

  Yes   No
If yes, when?

Have you ever brought animals to Elmsford?

  Yes   No
If yes, please explain:

Are you willing to have a representative of Elmsford come to see where the dog will be living?

  Yes   No
If no, explain:

Are you willing to take responsibility of this dog for the next 10 to 15 years?

  Yes   No
If no, explain:

What provisions will you make for the dog should you become unable to care for him/her?

How much are you willing to spend on medical bills for your dog?

  Up to $100   Up to $500
  Up to $1,000 Up to $5,000
  Whatever it takes
What would you do if the vet bills went over this amount?

Please provide one reference that is NOT your vet or someone living in your home:

Any additional comments?

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