Charleston Dog Shelter Adoption Application
Adoption Application Form
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Email *
Name of dog you are applying for? *
What are you looking for in a dog?
Applicant's name? *
First Last
Applicant's address? *
123 Example St. City, ST, ZIP
Applicant's phone number? *
479-555-1234
Applicant's alternate phone number?
479-555-1234
How long have you lived at the current address? *
How many people are in your household? *
How many people in the household are adults? *
How many people in the household are children? (please add ages for each) *
3. Johnny is 8. Jill is 4. Sam is 2.
Does anyone in the home have allergies to pets? *
Where will the dog live? Inside/Outside? *
If inside, do you work outside the home?
If YES, how long will the dog be crated each day?
Do you currently own any pets? *
If YES, please provide pet name, breed, age, sex:
Are your pets up-to-date on vaccines? *
Are your pets spayed/neutered? *
How many pets have you owned in the past 5 years? *
What is the status of each pet? *
Do you have a fenced-in yard? *
What do you consider a reasonable amount of time to allow for a dog to adjust to a new home? *
Veterinarian's Name: *
First Last, (and clinic name if known)
Veterinarian's Phone Number: *
479-555-1234
Non-Relative Personal Reference #1, with phone number *
John Doe, 479-555-1234
Non-Relative Personal Reference #2, with phone number *
Jane Doe, 479-555-4321
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