P.O. Box 1015
Waldorf, MD 20604-1015
Phone: 301 645-8181
Name:_____________________________________________________________________
Address:__________________________________________________________________
Telephone(include area code) (H)___________________(W)____________________
Directions:_______________________________________________________________
__________________________________________________________________________
What animal are you interested in adopting?_______________________________
Please circle the reason you want to adopt an animal:
Companion Guard Dog Gift To Breed Personal Protection For Child OtherIs someone home during the day?__________During what hours?_______________
Who will be responsible for this animal?__________________________________
Who will be responsible for housebreaking an untrained animal?____________________
Do you own your own home?___________Rent?___________Live with parents?__________
Is your residence a house?__________Townhouse?__________Apartment?______________
If renting, name and phone # of landlord________________________________________
How many children live in your home?____________List ages_______________________
Does any member of your family have allergies to animals?_______________________
When you go on vacation, who will care for your dog?____________________________
Do you anticipate moving soon?____________________Are you military?_____________
If you move, what will you do with your animal?_________________________________
What types of pets have you owned in the last five years? Type of animal Sex(M/F) Age Neutered(Y/N) What happened to it? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________Do you have a veterinarian now?________Vet's name___________________________
How much do you think it will cost to take care of this animal each year?
(Consider the cost of veterinary care, food, grooming, licensing, etc)
___________________________________________________________________________________
Have you adopted from us before?___________________________________________________
Do you have a fenced-in yard?_______ Fence height____________Type__________________
Where will the dog sleep?___________ and stay when away during the day?________________
How will the dog be confined when outdoors?_________________________________________
We require that all dogs adopted be spayed or neutered. Do you have any questions or reservations about this?_____________________________________________________
Do you understand that all puppies will require a series of distemper vaccinations and that adults will need an annual distemper vaccination as well as rabies?__________________
Rev. 08/95
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