Adoption Application Form

Name

First

Last

Secondary Name

First

Last

(Spouse, Partner, Roommate, etc…

Address

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone

Secondary Phone

Emergency Contact Name

First

Last

Emergency Contact Phone Number

Email

What Type Of Residence Do You Live In?

Do You Own Or Rent?

Years At Current Residence?

Do You Have A Securely Fenced Yard?

Yes
No

How Many Children Live In Your Home?

Have You Owned A Dog Before?

Yes
No

Please List The Name And Age Of Any Pet Currently Living In Your Home:

Do Any Of Your Current Pets Have Any Behavioral Issues?

Yes
No

If You Answered Yes, Please Explain:

What Brand Of Food Do You Feed Your Dog Or Cat?

Are Dogs Allowed On The Furniture In Your Home?

Yes
No

Do You Walk Your Dog With Or Without A Leash?

With
Without

Where Will A New Dog Spend The Day?

Where Will A New Dog Spend The Night?

In General, What Is Your Family's Typical Schedule?

On Average, How Many Hours Each Day Will A Dog Be Alone?

If Traveling, What Arrangements Will You Make For Your Pet's Care While You Are Gone?

Do You Have A Regular Veterinarian?

Yes
No

Please List The Name Of Your Veterinary Clinic

On my A

Is Your Current Pet(s) Current On Vaccinations?

Yes
No

What Heartworm Prevention Do You Give Your Pet?

How Often Do You Give Heartworm Prevention To Your Pet(s)?

Will You Have The Ability To Care For A New Pet For The Lifetime Of The Pet?

Yes
No

Do You Agree To Pay The $150 Adoption Fee

Yes
No

Is There Any Other Information You Would Like For Us To Know About Yourself Or Family In Regard To Adoption Of A New Cat Or Dog?

I Have Read And Agree To The Following: I understand that owning a pet is a lifetime responsibility. I agree that if I am chosen as the new owner of this pet, that I will care for him/her in the best manner possible including (but not limited to up-to-date vaccinations, wellness exams, heartworm and flea prevention, care when sic, etc…) I agree to provide vaccinationsand annual treatments for my pet's health either by Dr. Clark or another licensed veterinarian. I agree that all information abouve is true and correct. I understant that if any of my responses abouve are not true, Classen View Veterinary Clinic reserves the right to refuse adoption to any individual. I also understand that any pet adopted from Classen View Veterinary Clinic cannot be surrendered to a shelter or re-homed without written consent from Dr. Clark

Yes
No

Signature

By selecting the “Submit” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “Submit” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian. I may decline to electronically sign this document and withdraw my consent to sign this document electronically by contacting the signature requestor directly, which may delay transactions. I may contact the signature requestor separately to request to sign this document on paper or to receive a paper copy of the signed document. Any fees for such paper copy will be charged then by the signature requestor. When I sign the document, I will receive a copy of this document via email.