2. Have you ever adopted or attempted to adopt from another shelter? Yes No
Name of shelter & details

3. Is this dog a gift for someone else? Yes No

4. Have you ever owned a dog before? Yes No Presently own
Is/was the dog spayed/neutered? Yes No
How old is/was your dog(s)?
If you no longer have your dog, what happened?

If you had a female who was not neutered, how many litters did she have?
Other comments:

5. Do you currently have other pets? Yes No
Pet type: Age: How many pets do you currently have?

6.Who is your veterinarian? Vet Phone#:
Town: Zip Code: State:
Account in name of
Pet's name
Years the animal treated at this vet?
Are/were your pets up to date on all shots? Yes No

7. How many people live in your household?
Adults:
Children (specify ages):

Will all members of your household be present when you visit the shelter? Yes No
Are all of the adults in the household know that you are planning to adopt? Yes No
Are all adults agreeable to the adoption? Yes No

8. Do you:

If renting, does your lease allow pets? Yes No
Landlord's Name Landlord's Phone

9. Who will be the main person caring for the dog?

10. Is anyone home during the day? Yes No

11. Do you have a fenced in yard? Yes No

12. Will you agree to have this dog spayed / neutered? Yes No already done

Do you fully understand that if the dog is not spayed or neutered TBAW will take the dog back (with the assistance of the Animal Control Officer)? Yes No

13. How will you discipline the dog when it misbehaves? (i.e., chewing, accident in the house, etc.)

Are you willing to and do you have the time to go to obedience class should it become necessary?
Yes No

14. Are you financially able to care for this dog? Feeding, routine medical care such as vaccinations, heartworm tests and pills, exams, emergency medical care, licensing, etc. Yes No

15. What provisions will you make for this dog if you must go out of town or away on vacation?

16. Are you willing to take responsibility for this dog for the rest of it's life? Yes No

17. Can you make this commitment for the many years a dog can live (10-18+)? Yes No

18. Do you agree to return this dog to TBAW should the adoption not work out or if you need to give the dog up at some time in the future? Yes No

19. Additional Comments: