Adoption Application

Name (required)

Email (required)

 Yes, I'm at least 21 years old

Phone (required)

Address (required)

City, State, ZIP (required)

Apartment Complex Name and Landlord Contact Info

Name of dog you are interested in (required)

Have you ever applied for or adopted a dog from THIS shelter? (required)
 Yes No

Have you ever applied for or adopted a dog from ANOTHER shelter? (required)
 Yes No

If Yes, which shelter?

Why are you interested in adopting a dog? (required)
 Family Pet For Children Gift Guard Dog/Protection Companion for Other Pets Other

If Other, please explain

Do you rent or own your home? (required)
 Rent Own

Type of dwelling? (required)
 Apartment House Other

If Other, please explain

Does your landlord require a pet deposit?  Yes No

If Yes, how much is the pet deposit?

How many adults live in your home?

How many children live in your home?

Children's ages?

Do any children visit your home on a regular basis?
 Yes No

Ages of visiting children?

How often do they visit?

Are any household members allergic to dogs?
 Yes No

Is everyone in your home aware you are planning to adopt a new dog?
 Yes No

Who will be primarily responsible for this dog? (required)

This dog will live: (required)
 Indoor Outdoor Both In/Out

How will you exercise this dog? (required)
 Outdoor Pen/Fenced Yard Tie Out Walks 1-2x Daily Walks 3-4x Daily Other

If Other, please explain

Please estimate the annual cost of caring for this dog. (required)

Please list any animals you currently own or have owned in the past. Include their name, breed, sex, age, whether they were spayed/neutered, how long you owned them, and what happened to them.

Are your animals up to date on their vaccinations?
 Yes No

What heartworm preventative do you use?

Name and phone number of your veterinarian

Your electronic signature authorizes Yelp!BR to contact your vet for reference.

How did you hear about Yelp!BR?