Dog Adoption Application

I am interested in adopting:(*)

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Animals Name:(*)
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Age of Applicant(*)
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Age of Co-Applicant
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Do you life with your parents:(*)
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Name:(*)
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Address:(*)
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City, State, Zip:(*)
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Email Address:(*)
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Cell Phone:(*)
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Home Phone:(*)
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Type of home you live in:(*)

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If renting, please provide the contact number of whom you rent from for pet allowance verification:
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How long have you lived at current residence:(*)
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How many adults reside in your home:(*)
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How many children live in your home?(*)
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Age(s) of Children (If applicable)
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Are all household members in agreement with adopting this dog?(*)
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Do any members of the household have allergies:(*)
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If yes to allergy question above please explain:
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Who will be the primary caregiver to the dog? (*)
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What is your reason for wanting to adopt this dog? (check all that apply)(*)

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Please explain if answer was "other" above.
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Who will be responsible for caring for the dog during your absence:(*)
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Who is your current/previous veterinarian? (Clinic name and phone number)

1st Vet name/clinic name:
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1st Vet clinic number:
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2nd Vet name/clinic name:
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2nd Vet clinic number:
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How often do you take your pet(s) to the vet?
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Date of last veterinary visit:
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Do you presently have any other pets?(*)
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If yes to above please complete the following:

1. Pet's Breed, Age, Name:
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1. Pets sex:
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1. Pet's Current Health:

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2. Pet's Breed, Age, Name:
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2. Pets sex:
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2. Pet's Current Health:

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3. Pet's Breed, Age, Name:
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3. Pets sex:
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3. Pet's Current Health:

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How much time do your current/previous pets spend outdoors?
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How much time and in what condition (cage/leash/roam) will this new dog spend outdoors?(*)
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This yard is:(*)

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The fence is:(*)

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If your yard is not fenced - how do you plan on keeping your dog contained in your yard:
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How many hours a day would this dog be left alone?(*)
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Where will the dog be kept when left alone(*)
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What other pets have you had in the last ten years?(*)
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How long did you have them?
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Where are they now?
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Have you ever had to return a pet to a breeder or taken it to a pound, shelter, or rescue?(*)
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For what reasons would you consider giving up a pet? (check all that apply):(*)

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Please explain if answer was "other" above.
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What Behaviors would you be UNABLE to tolerate from an adopted dog?

Check all that apply:(*)

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Methods I plan to use to discourage unwanted behavior(s):

Check all that apply:(*)

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What arrangements have you made to care for the dog in the event you can no longer do so or you have to move?(*)
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Rescue animals require time to adjust to their new home. What amount of time do you consider to be reasonable for this adjustment?(*)
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The average cost per year for providing preventative vetrinary care is $200. Additionally, there are expenses for food, toys, grooming, boarding, emergency vet care, etc. to consider. Does your household budget allow you to comfortably cover these expenses? (*)
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Would you object to a Basils Buddies representative visiting or calling to inquire about the dog after placement?(*)
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I understand that completion of this application will, in no way, guarantee the adoption of this dog, and I understand that electronic signatures are valid when the application is returned electronically.

The information which I have provided to Basil's Buddies for the purpose of adopting a dog is accurate and complete.(*)
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Signed:(*)
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Date: (*)
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