Online Canine Adoption Application

CANINE ADOPTION APPLICATION

Date:*
Name of Dog(s) you are interested in adopting:*
This dog will go home up to date on vaccines, spayed/neutered, and micro-chipped.

Thank you for choosing adoption! Please take a few minutes to tell us about yourself.

Name of Applicant:*
Address:*
Primary Phone Number:*
Alternate Phone Number:
Email Address:
Number of Persons in Household:*
Relationships:*
Number of Children:*
Ages of Children:
Do you plan on having any children in the future?*
Do you*
Type of Dwelling:*
If you rent, does your lease have any restrictions on number or types of pets?
Do you have pets at home already?
How many?
How would you rate your dog experience?*
How many hours a day will the dog be alone?*
Describe your home atmosphere:*
What was your primary reasons for adopting a dog?*

How will your dog get exercise and outdoor time?*
Where will the dog stay when he/she is home alone?*
Who, other than members of your household, has access to your home when you are not there?*
What areas of the house would be off-limits to the dog?*
Where will the dog sleep at night?*
Does any member of your household suffer from animal related allergies?*
If yes, do you have a plan for dealing with this or would you like more information?
What kinds of dogs have you owned in the past?*
What would prompt you to return this dog? Do you have any deal-breakers?*
Is there anything else about yourself that you would like to share with us?*

By clicking the submit button, you agree to the following: "I am prepared to make a lifetime commitment to care for my pet, including medical care, grooming, a healthy diet, shelter, exercise and love. I am prepared for veterinary expenses, including emergency medical costs that will be incurred during my pet's lifetime. I have a contingency plan in case circumstances cause me to vacate my current premises and I have trouble finding a place that allows pets. I certify that the information on this form is true, and I realize that any false information given may result in nullifying the adoption."

Pet Orphans of Southern California reserves the right to refuse to adopt to any applicant for any reason.
The Adoptions Coordinator will call you to discuss your application. If you would like to discuss any of the following topics during that conversation, please check them here:
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