| Adoption Application For: |
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| Applicants Name: |
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| Co-Applicants Name: |
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Complete Physical Address:
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| County: |
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| Home Phone: |
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| Cell Phone: |
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| Work Phone: |
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| Email Address: |
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| Occupation: |
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| Do you Rent or Own this residence?: |
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| How long at this address? |
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| If renting, Does your landlord allow large breed dogs?: |
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| Landlord's Name: |
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| Landlord's Phone Number: |
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| Will this dog be kept as an inside pet?: |
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| Are there stairs in your home?: |
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| Do you have a completely fenced yard?: |
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| Height and type of fence (picket, chainlink, etc): |
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| Do you have a pool?: |
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| Number of children in the home: |
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| Names and ages of children: |
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| Is there anyone in your home with special needs? (walker, wheelchair, etc.): |
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| How many hours per day will your greyhound be alone?: |
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| Please list Names, Breeds, Ages, and Sexes of ALL CURRENT DOGS: |
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| Are ALL CURRENT DOGS Spayed or Neutered?: |
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| Are ANY CURRENT DOGS outside pets? |
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| Are ALL CURRENT DOGS up to date on vaccinations? |
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| Are ALL CURRENT DOGS on Heartworm Preventative? |
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| If Yes, what type of Heartworm Preventative? |
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| If No, why are your current dogs not on Heartworm Preventative? |
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| Name of Animal Hospital: |
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| Phone Number: |
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| Please list Names, Ages, and Sexes of ALL CURRENT CATS: |
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| Are ALL CURRENT CATS Spayed or Neutered?: |
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| Are ALL CURRENT CATS indoor pets?: |
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| Are ALL CURRENT CATS up to date on vaccinations? |
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| Name of Animal Hospital: |
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| Phone Number: |
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| Please list any additional pets (birds, rabbits, guinea pigs, etc.): |
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| If you do not currently have a dog, have you had one in the past?: |
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| Prior dog's name and breed: |
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| Previous Animal Hospital: |
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| Phone Number: |
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| Do you agree to keep your greyhound on a leash at all times when not in a fenced area?: |
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| Preferred Gender: |
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| How did you hear about our group?: |
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| Would you be interested in becoming a volunteer? or a foster home?: |
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| I hereby certify that all information in this application is true and correct. Name: |
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| Date: |
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