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SAD EYES ANIMAL WELFARE SOCIETY
ADOPTION APPLICATION

Please tell me about yourself and your home?

Date
Dog's Name
Last Name
First Name
Address
City
State Zip Code
Home Phone Cell Phone
Email
Employer
Address
Own Rent
House Condo Townhouse Apt Trailer
Length of Residency
Landlord Name
Landlord Phone
How many people live in your home?
Please list Names & Ages

Tell us about your readiness to own a Dog.

Why do you want to adopt a dog?
Who will be responsible for the dog's care?
Where will the dog sleep?
Will you use (check all that apply)? Runner Chain Kennel Dog House
Fenced Yard? Y N
Height?
How much time per day will the dog be left alone?
Do you agree to a pre-adoption home visit? Y N
Do you agree to a post-adoption & follow-up visits, calls and/or e-mails? Y N
Do you own other pets? Y N ( use commas below to separate info on multiple pets)
Names
Breeds
Ages
Spayed/Neutered?
Are owned pets licensed in you municipality? Y N
Owned any other pets in the last 5years? Y N
Where are they now?
Ever surrender an animal to a shelter?
What were the circumstances?
Vet Reference
Vet Address & Ph#
Has anyone in the home ever been charged with an animal neglect or cruelty complaint?
Y N
By checking this box and submitting this application, I certify, that the information I have provided on this form is true and accurate. If any info is found to be intentionally false it will reault in the denial of this application and the adoption process.

I certify that all of the above information is true. I hereby authorize the release /disclosure of any records and/or pertinent information including employment verification, tenancy, and veterinary/personal references.
I understand that any false information given on this application will disqualify me from adopting.
Sad Eyes Animal Welfare Society reserves the right to deny any application it deems unsatisfactory.