148 Bingham Industrial Drive Denton, North Carolina, USA 27239
[email protected]
336.963.0575

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Adoption Application Form

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Adoption Application Form

The adoption application must be filled out and returned before we can proceed with matching you with one of our Adult Trained Dogs.

Adopter Information

First Name *

Last Name *

Phone Number *

Email*

Occupation *

Address Line 1 *

Address Line 2

City *

State*

Zip Code *

Country *

Adopter Residence Information

Description of Residence *

Do You Have A Multi Level House *YesNoSecond House

Type of Stairs *

Type of Stairs (Other)

Is There A Balcony? *YesNo

What Kind Of Rails?

Width Between Rails?

Do You Have Any Of The Following? Sliding Glass DoorsMirrored Closet DoorsGlass Tables

What Type Of Flooring Is In Your Home? *CarpetingHardwoodTileLinoleumOther

Type Of Flooring (Other)

Do You Have A Garage Door? *YesNo

What Is The Size Of Your Yard? *

Type Of Fencing? *

How High Is Your Fence?

Where Will You Want The Dog To Eliminate? *

Elimination Area (Other)

Do You Have A Patio? *YesNo

What Type Of Rails? Width Of Rails?

Do You Have A Large Outdoor Umbrella? *YesNo

Do You Have An Outdoor Swimming Pool? *YesNo

Will The Dog Be Allowed in the Pool? (Required if you answered Yes to Outdoor Swimming Pool)YesNo

Do You Have Playground Equipment? *YesNo

Do You have Stairs Outside? Type? Height? *

Do You Have Excercise Equipment The Dog Will Be Exposed To? *YesNo

Does Your Neighbors' Yard Adjoin Yours? Type Of Fence Divider? *

Do Your Neighbors' Have Any Of The Following? (Check All That Apply)ChildrenDogsCatsFarm Animals

Location Of Your Residence? *

What Type Of Road/Street? *

Adopter Family Information

Pets You Currently Own? * (Check All That Apply)Dog(s)Cat(s)Caged Animal(s)None

Are They Spayed/Neutered? YesNo

List Previous Pets You Have Owned.

Description Of Family. Number Of Seniors, Adults, Children and Children Ages. *

Do You Or Your Children Play Musical Instruments? *YesNo

Are You Or Your Children Involved In Sports? *YesNo

Will You Be Taking The Dog To Sporting Events? * YesNo

Do You Have Children That Are Pushed In A Stroller? * YesNo

Activity Level Of Household/Children? *

Do You Have Children In College That Will Be Home At Certain Times? * YesNo

Do You Have Other Family Or Friends That Will Live In Your Home From Time To Time? * YesNo

Do You Have Grandchildren That Will Be Visiting? * YesNo

Is There Anyone That Lives In Your Home Or Visits, That Has Any Type Of Disability Or Handicap? *YesNo

If Family Member, please explain?

Will The Dog Be A Companion For The Disabled/Handicapped Person? *YesNoNeed Service Dog

Do You Or Any Family Member Have Arthritis Or Joint Problems That Will Make It Dificult To Hold Or Use The Leash Clasp Or Collar For The Dog? * YesNoHandicapped

Are You Or Any Member Of Your Family Allergic To Pets? *YesNoA Little

Have You Ever Had A Dog Trained Or Taken A Dog Through Training? * YesNoTried

What Type Of Training Collars Have You Used? *

Have You Ever House Broken A Dog Before? * YesNoTried

About the Adult Trained Dog You are Seeking

Basic Description Of Dog Desired. Weight And Size Of Dog. Age Of Dog. Oldest Dog Considered. *

Training Level Of Trained Adult Pet Dog?*

Do All Members Of This Househould WANT This Dog? *YesNo

The Applicant And Significant Other Must Know About And Agree to Purchase The Dog!!!*

Will You Want The Dog To Accompany You To The Office/Work? * YesNo

Please Provide Two Personal References and a Vet Reference?*

Provide Any Additional Comments.

Application Completion

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Rolling Meadows Academy of Adult Trained Dogs

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(336) 963-0575
[email protected]
148 Bingham Industrial Drive, Denton, NC 27239

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