APPLICATION FOR DOG ADOPTION

ADOPTIONS ONLY WITHIN A 100 MILE RADIUS OF THE

INDEPENDENCE/KCMO AREA

Veterinarian Reference Showing a History of Good Pet Ownership, including a minimum of FIVE years consecutive vet history to include yearly vaccines and heart worm preventative is REQUIRED.

Please list name and age for yourself and all occupants of your home:

Street Address / City / State / Zip:

Daytime Phone:

Evening Phone:

Email Address:

Ownership

Own

Rent

If you rent or lease, list the name and phone number of the landlord or property owner:

Describe your yard:

Type and Height of fence / Improvements needed, if required:

Where will your dog be kept most of the time:

When at HOME where would your pet stay:

When at WORK where would your pet stay:

At night, describe your pet's sleeping quarters:

How many hours a day would your pet be alone?

Less than 6 hours

6 to 12 hours

More than 12 hours

How would you exercise your pet?

How do you house train your pet?

Name of Pet / Age / Breed (Pet #1):

Type of pet / Spayed or Neutered?

Is your pet current on vaccinations?

Yes

No

Name of Pet / Age / Breed (Pet #2):

Type of pet / Spayed or Neutered?

Is your pet current on vaccinations?

Yes

No

Name of Pet / Age / Breed (Pet #3):

Type of pet / Spayed or Neutered?

Is your pet current on vaccinations?

Yes

No

Name of Pet / Age / Breed (Pet #4):

Type of pet / Spayed or Neutered?

Is your pet current on vaccinations?

Yes

No

If your animals are on heart worm preventative, indicate type(s)

Present Veterinarian / Clinic name:

Street Address / City / State / Zip:

Phone Number:

Past Veterinarian / Clinic name:

Street Address / City / State / Zip:

Phone Number:

If you have owned other dogs / cats and do not now, what hapened to them? (Disease / illness / ran away)?

If you have ever had to give a dog / cat up, what was the circumstance?

If you have ever owned a pet with behavioral or training problems, explain actions taken:

What would you do, if for any reason (moving, health issue, etc.), you can no longer care for your pet:

Name of the animal(s) you are interested in and if you want to FOSTER or ADOPT:

What type of personality are you looking for?

Check any of the following you feel are valid reasons for giving away a pet:

A home visit is required. When would that be convenient?

Do you agree to return the animal to ABF if for any reason during it's lifetime you can no longer care for it:

How did you hear about us?

If referral by friend - Name:

I understand that if my application is selected, I will be contacted by phone within 5 days. If I am not contacted within that time, I understand that other applicants are being pursued:

Date

Month

Day

Year

Signature:

ABF retains the right to refuse any application. By checking this box and / or signing this form, I acknowledge and agree to accept all terms and conditions herein.

I agree.

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APPLICATION FOR DOG ADOPTION