Adoption Application : Dogs by Debin

Your Full Name*

First Last

Email address*

Partner or Spouse's Name

First Last

Phone Number*

Secondary Phone Number (Work, friend, etc)*

Physical Address Where Dog Will Live*

Street Address City State ZIP Code

Do You Have Children That Live with You or Visit? (17 years old or younger)*

If Yes, What are Their Ages and How Often Do They Visit?

Is There a Specific Dog You are Interested In? (Name)

Preferred Gender?*

Desired Age? (Check any that apply)*

Do You Have Other Indoor or Outdoor Pets?*

If Yes, Please Tell Us About Them

Have You Ever Given Up a Pet?*

If Yes, Please Tell Us the Circumstances

Veterinarian of Reference Name & Phone Number. (If no Vet, who do you intend to use?)*

(Make sure you please list the phone number!)

Do You Own or Rent Your Home?*

If You Rent, Landlord's Phone Number or Explain "Other"

(Make sure you please list landlord's phone number!)

Is Your Yard Fenced? (This will not exclude you. It merely helps us find a match for you)*

If Fenced, How Tall & What Material?

Please Provide 1 Personal, Non-related Reference (Name, phone number & how you know them)*

(Needs to be non-related & we need a phone number!)

Tell Us What Temperament, Size & Any Other Information That Will Help Us Pair You With your New Friend...*

Where Do you Plan to Keep Your New Family Member During the Day & at Night?*

How Did you Hear About Us?*

Any Other Information that May be Useful?

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