First Name*
Last Name*
Address*
City*
State* Zip*
Previous Address/Location*
Email*
Email Verify (Please type again)*
Home Phone* ( ) -
Cell Phone ( ) -
Work Phone ( ) -
Skype Name
Occupation
Job Description:
Age*
Drivers License #
License State
Family Status
Single
Married
Have roommates
Yes
No
How Many
Have children
Yes
No
Ages of Children
Interested in: Morgan
My housing
Own House
Own Condo
Rent House
Rent Condo
Own Mobile Home
Rent Mobile Home
Military Housing
Other
Have screens on windows?
yes
no
Have secured fencing in yard?
yes
no
'Morgan' will be kept
Inside
Outside
Both
During Day
Inside
Outside
During Night
Inside
Outside
Location inside, either during the day or night
All rooms in the house
The bedroom
The living room
The kitchen
The garage
Other
Location outside, either during the day or night,
Protected from the elements ( rain / sun etc )
Unprotected - Open to the elements, with no shelter
Both
Other
Length of time at current address
years
months
Landlord Name*
Landlord Phone*
Current Pets:* Please include all pets, including small caged and barnyard animals
and list the following for each pet: Type of Pet, Age, Sex, Spayed/Neutered, Kept In/Out, How long owned
Pet History:* Please list pets owned in the past 5 years (other than those above)
and list the following for each pet: Type of Pet, Spay/Neutered, Kept In/Out, How long owned, What happened to pet
Veterinarian:* Please enter the following if you currently own animals or if you have owned
animals in the past: Veterinarian Name, Address, Phone
Responsibility:* Who will be responsible for the pet’s care?
Experience Level Please describe your experience with owning a dog:
1
2
3
4
5
( 1=No experience to 5=Lots of experience )
Experience: Please explain in detail your experience in owning a dog from the rating above:
Temperament: What type of temperament are you looking for in a dog and why?
Exercise: How often will you exercise your dog and how much exercise do you think a dog needs weekly?
Training: Have you ever attended any dog training classes ( if so when/what type)? If needed would you be willing to attend training with 'Morgan'?
About:* Why are looking to adopt a dog or specifically 'Morgan'?
Length of time during the day 'Morgan' will be left alone?*
hours
minutes
If extended trip,'Morgan' will be taken care by?
family
friends
neighbor
petsitter
petboarding facility
Potential mismatch:*
What do you consider an acceptable reason for giving up an animal?
References:*
Comments or Questions:
Where did you hear about AHAN?
Google
Yahoo
Petfinder.com
Craigslist
Other Search Engine
Word of Mouth - friend, family
Bay Area resource - flyer, poster, protest
Other
Have you ever adopted an animal from a shelter, rescuer group or organization before?
Yes
No
If yes, what was the name and city of the shelter, rescuer group or organization:
Were you satisfied with your experience with them?
Not applicable
Satisfied
Unsatisfied
If not satisified, what was the reason:
Pictures of your family, pets, house(inside) and backyard (jpgs or jpegs only) Not Required but helps us speed up the application process and is preferred.
Family
Pets
House (Inside)
Backyard
I hereby authorize to release AHAN all veterinary records on any and all animals I own or have owned: Yes No
Please download the following adoption agreement for 'Morgan' now.
I have downloaded and read the following the adoption agreement above, am willing to abide by it and will sign it if I am selected to adopt the animal as well as I am willing to pay an adoption fee which covers the animal rescue, adoption and medical expenses. *** Important Application Printing Instructions *** Yes No
I certify that all the information in the application is true and I understand that false information may void the application and I understand that submitting of this application is no guarantee that I will be able to adopt the animal that I have selected to adopt. Yes No
Security Field to Prevent Automatic Form Submission: Please select a color from the following pulldown: *
cat
blue
dog
zebra
elephant