Adoption Application* indicate required informationDog Name (if applicable) or type interested in:Adopters and Adult Residents in HousePlease include spouse, partner, roommates, children 18+, friends, parents, etc.Primary - Name* First Last Phone*Email* Place of Employment*Drivers License State and NumberHow did you hear about Save-A-Mutt?*Do other adults (age 18+) live in the home part time or full time?*YesNoPlease list all other adults (age 18+)*Full NameEmailPhonePlace of EmploymentRelationship Home InformationHome Address (where your pet will be living)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home TypeHouseCondominiumApartmentOther RentalHome StatusOwnRentLive with someoneAre pets allowed?YesNoLandlord Information*Landlord Full NameLandlord Phone NumberBy providing this information, you acknowledge that we will be contacting your landlord. How long have you lived at your current address?Do you plan on moving within the next year?YesNoIf you move in the future, what will you do with your pets?Do you have children at home?*YesNoChildren InformationHow Many?Ages?Are you children used to animals?YesNoIs anyone living in the house allergic to animals?YesNoDo all adult members of the household know you plan to adopt a pet?YesNoDog LifestyleWhy do you want to adopt this animal? Companion Companion for Kids Companion for other Pet(s) Guard/Watch Dog Hunting Dog Gift / Present Other Please check all that apply.You selected "other" please elaborateWhen this dog is outside, it will primarily be:In a Fenced YardOn a LeashAllowed to Run FreeTied Up/TrolleyOtherIf the yard is fenced, will it safely contain the dog?YesNoFence DetailsType of FenceHeight of Fence What type of outside shelter will be provided?Are you willing to enroll the dog in an obedience class?YesNoWhat type of activities do you foresee doing with your dog?Would you allow our representative to do a home check prior to adoption?YesNoDog Care and WellnessList ALL current, deceased, or rehomed animals or pets you have had in the last 5 years:NameType / BreedAgeGenderFixed?Current Status Are all of your pets current on their vaccinations?YesNoDo you currently have a veterinarian?YesNoVeterinarian InformationNamePhone NumberBy providing this information, you acknowledge that we will be contacting your veterinarian.How much are you willing to spend on vet bills per year?Are you willing to obtain pet insurance for your new pet?YesNoAre you aware of the financial commitment of owning a pet?YesNoHow many hours pers day will the pet be alone (without HUMAN companionship)? This is while at work, errands, etc.*Where will the pet stay during the day?*Where will the pet stay during the night?*Will this pet be allowed indoors?YesNoWhere will this pet sleep at night/bedtime?ReferencesPlease use references with email addresses only. It is our preferred form of communication. Reference Information*NameE-Maill AddressRelationship Type Reference Information*NameE-Maill AddressRelationship Type Reference Information*NameE-Maill AddressRelationship Type Is there any other information you would like us to know in regards to adopting from Save-A-Mutt?Signature and Legal InformationBy signing below, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of adopting a companion animal from Save-A-Mutt. This pet will reside in my home as a companion animal. I will provide it with adequate food, water, shelter, training, affection and medical care. I am in full agreement with these terms of adoption. Save-A-Mutt is in no way liable or responsible for any damage, accident or injury resulting from the placement of a pet in my household. Thank You.Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.
