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COMPANION CRITTERS, INC.
DOG and PUPPY ADOPTION APPLICATION

The following information is requested so we can assist you in the selection of a new pet.  The animal's welfare is our foremost concern. The consultation process is designed to help us assist you in finding the animal most compatible to your lifestyle.

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Name Animal Interested In :

The reason I want this particular pet is:

Are you over 18 years of age?

I am adopting for (please X one):
     Myself
     Another person
     As a gift

I am prepared to adopt this pet (please X one)
     Immediately
     A week from now
     A month from now
     Other:  

Name:

Address:

City, State, Zip:

Home Phone:

Work Phone:

E-Mail Address:

How did you hear about Companion Critters, Inc.?

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Please complete all of the information.  By e-mailing this application, you certify that you understand the following:
     1)  Companion Critters, Inc. reserves the right to refuse adoption to anyone.
     2)  The information contained within this application is accurate and not misleading in any way.
     3)  Companion Critters, Inc. reserves the right to contact any individual on this form.

Please give careful consideration to adopting a pet.  Animals are not toys or short term commitments.  Make sure that your lifestyle allows the time, patience and expense this pet will need over the years. Animals for adoption are placed with adopters with full consideration
given to the specific needs of each animal.

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Is this your first experience with a pet?

Do you currently have other pets at home?
    If yes, please list for each pet:
    TYPE (cat or dog):
    BREED:
    AGE:   
    NAME:
    SPAYED OR NEUTERED?  
    REGULARLY VACCINATED?
    ON HEARTWORM PREVENTATIVE?  
    KEPT IN OR OUT?
    HOW LONG OWNED?
    DOES THIS PET GET ALONG WITH OTHER ANIMALS?

Have you had any pets in the past?
If yes, please list for each pet:
    TYPE (cat or dog):
    BREED:
    AGE:   
    NAME:
    SPAYED OR NEUTERED?  
    REGULARLY VACCINATED?
    ON HEARTWORM PREVENTATIVE?
    KEPT IN OR OUT?
    HOW LONG OWNED?
    WHAT HAPPENED TO THIS PET?

Have you ever taken a pet to a shelter?  
     If yes, please describe circumstances:

Who is/was your veterinarian?
     Name:
     Address:
     City, State, Zip:
     Telephone:
     Approximately when was your last visit?
     Under who's name (owner) are the pet's records?
     May we contact your veterinarian?

How long have you resided at your present address?

Do you currently live in a house or apartment?

Do you own or rent?
    If you rent, does your lease allow pets?
    Landlord's Name:
    Telephone Number:
    May we contact your landlord?

What would you do with a pet if you had to move where pets aren't allowed or if you were no longer able to care for your pet?

Under what circumstances would you consider it necessary to give up your pet?

How many people live in your household?
    Do all the adults know you plan to adopt?
    If there are any children in the household, list ages:

Does anyone in your household have any known allergies to animals?

Where will this pet be kept during the day?
Where will this pet be kept at night?

Is anyone home all day?
    If no, how many hours will the pet be left alone in a 24 hour period?

Where will the pet be kept when alone?

Are you financially prepared to give your new pet routine and emergency medical care as well as professional grooming, if needed?

Would you be willing to let a representive of Companion Critters, Inc. visit your home by appointment?

Do you want the dog for a (X all that apply)
     house pet
     guard dog
     watch dog
     companion
     gift
     breeder
     companion for another pet
     other (please describe):

Do you realize you might have to housetrain a dog or that a housetrained dog could experience accidents while adopting to a new home?

Do you know how to housebreak a dog or reinforce housetraining?  Please explain.

Are you familiar with crate training?
     Do you own a crate?

Are you familiar with leash and licensing laws in your community?

Are there regular visitors to your home (human or animal) with which your new dog must get along?
If so, please describe:

How will you keep your dog confined to your property (X all that apply)
     outside dog pen/dog run
     invisible fence
     fenced yard
     on chain
     garage
     patio
     on leash
     other:

Do you have a fenced yard?
    If yes, how high is the fence?
    Does the fencing completely enclose the yard?

If you do not have a fenced yard, how will you handle the dog's exercise and toilet duties?

What will you do if your dog chews furniture or shows other destructive behavior?

Would you be willing to attend obedience classes?

Have you ever formally obedience trained a dog before (attended obedience classes)?

To help us determine if the dog's activity level is compatible with your lifestyle, please indicate which activities you and/or your family would want to participate in with your dog:
     occasional walks
     daily walks
     hiking
     jogging
     occasional car rides
     frequent car rides
     long car trips
     camping
     agility
     obedience competition
     boating
     swimming
     therapy dog visits at hospitals/nursing homes
     taking dog to work
     other:

We request a minimum donation of $150.  The donation is to help offset the costs incurred for veterinary care.  Each animal coming through rescue costs us an average of $300 and the rest is made up through donations and fundraisers.  Is this acceptable?

For puppies under the age of 6 months, we require an additional $50 deposit which is refunded upon proof of completion of a puppy training or obedience course.  Is this acceptable?