Hi! Have we met somewhere before...? I have already visited the shelter to meet the dog I want to adopt! * Have you come to see us yet, and spent time with the dog you would like to adopt? Yes No I met my perfect dog on: If you have already met the dog you would like to adopt, when did you visit? MM DD YYYY I dealt with: Name of the Sammy's Hope staff or volunteer who introduced you (if you remember!) Great! Now please tell us about yourself Name * Name First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mobile Phone * Mobile Phone (###) ### #### Home Phone Home Phone if different than Mobile (###) ### #### Email * Driver's License Number Age * 18-20 21-25 26-40 41-50 51-64 65+ Occupation Employer Will this pet be co-owned by another person? * Yes No Co-owner Name If so, please provide the following: First Name Last Name Co-owner Phone (###) ### #### Co-owner Driver's License Co-owner Email Co-owner Age 18-20 21-25 26-40 41-50 51-64 65+ How did you hear about Sammy's Hope Animal Adoption & Welfare Center? Petfinder, Adopt-a-Pet, etc. Sammy's Hope Website Facebook Twitter Instagram Friend/Relative Prior Adopter Other Other: If you chose "other" please tell us where you heard about us: Do you live with: Spouse/Partner Children Parents Roommate Alone How many adults (21+) live in your household? How many people under the age of 21 live in your household? What are their ages? Have you received permission to adopt from each adult in your household? Yes No Do you live in: * House Townhouse Apartment/Condo Other Do you rent or own your home? * Rent Own Other/Live with family/friend If you rent, does your lease allow pets? Please note that you must provide a copy of your current lease prior to finalizing an adoption Yes No I don't know If renting, what are your lease restrictions regarding pet ownership (size, breed, type, number, etc) What setting is your home in? Urban Suburban Rural Do you have a yard? Yes No If yes, is any portion of your yard fenced? Yes No If your yard is fenced, please provide fence type (chain link, stockade, etc) and height: At its closest point, approximately how many feet is your fence from a sidewalk or road? Is your house on a corner lot? Please note that some dogs may not be a great fit for homes with yards that have fences on close proximity to sidewalks and public foot traffic. Yes No Do you share your yard with another family, renter, or owner? Yes No If yes, describe shared usage (pets, children, etc) Lifestyle and Experience Please describe your household/lifestyle: Active - many visitors in and out, travel a lot, hiking, running, camping, etc Relaxed/Structured - quiet household, not many visitors, structured daily routines, etc Do you currently have any other pets living in your household? * Yes No If yes, please tell us about them! Please list your current animals, and provide the following details of other dogs in the home: sex, age, and whether they have been spayed/neutered: Are all dogs currently in your home licensed? Yes No If you have had other dogs in the past, please let us know what happened to them: Check all that apply Died of old age Died of a fatal disease Gave away to friend or relative Gave to a shelter Hit by a car Lost/Disappeared Other If "other" please explain: What arrangements would you make for the care of your pets in case of an emergency or if you become unable to care for them? Have you ever been convicted of an offense other than a traffic violation? Yes No If yes, please explain: Tell us about the dog your are interested in adopting Choice #1 What did you like about this dog? Choice #2 Tell us who else caught your eye as a potential adoption? What did you like about this dog? Dog's living situation Dog's living situation will be: Please select all that apply House pet, living inside with a family Will live in basement of garage Will live outdoors Dog house will be provided Guard dog for business Guard dog for home If "other" please explain: How many hours per day will the dog be home alone? When home alone, dog will be: Choose all that apply In a crate, wire cage or dog pen indoors In an indoor kennel In an outdoor kennel Tied up outside on a cable run Tied up outside on a chain Loose indoors Loose outdoors Other If "other" please specify: How will you exercise your dog? Please check all that apply Leash walks every day Will have cable or dog run in the yard Will be free to run in a fenced yard Will be free to run in a yard with an invisible fence Will have unsupervised access to unfenced yard WIll bring to dog park Other If "other" how will the dog be exercised? References If you have owned pets in the past, or see a veterinarian for your current pets, what is the name of the vet office? Name of the primary doctor seen? Name of pets in their care? Name of a non-family member personal reference: (only required if you do not have a veterinarian reference) First Name Last Name Phone of personal reference (###) ### #### Years acquainted? Do you agree to take the dog for a veterinary exam within 7 days of adoption? Yes No Is there anything else you would like us to know? Sign-off: * I certify that all information is true and complete, to the best of my knowledge. Thank you for applying to adopt from Sammy’s Hope!
