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
*
—Please choose an option—
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American Samoa
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Zip Code
*
Country
*
—Please choose an option—
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Arctic Ocean
Aruba
Ashmore and Cartier Islands
Atlantic Ocean
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Austria
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Bahrain
Baker Island
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Adopter Residence Information
Description of Residence
*
House
Condo
Town House
Apartment
Farm
Do You Have A Multi Level House
*
Yes
No
Second House
Type of Stairs
*
None
Open Face
Spiral
Closed Face
Type of Stairs (Other)
Is There A Balcony?
*
Yes
No
What Kind Of Rails?
Width Between Rails?
Do You Have Any Of The Following?
Sliding Glass Doors
Mirrored Closet Doors
Glass Tables
What Type Of Flooring Is In Your Home?
*
Carpeting
Hardwood
Tile
Linoleum
Other
Type Of Flooring (Other)
Do You Have A Garage Door?
*
Yes
No
What Is The Size Of Your Yard?
*
Type Of Fencing?
*
Chain Link
Wrought Iron
Invisible Fence
Block/Brick
Wood
No Fence
How High Is Your Fence?
Where Will You Want The Dog To Eliminate?
*
Grass
Natural Area
Walk To Potty Area
Other
Elimination Area (Other)
Do You Have A Patio?
*
Yes
No
What Type Of Rails? Width Of Rails?
Do You Have A Large Outdoor Umbrella?
*
Yes
No
Do You Have An Outdoor Swimming Pool?
*
Yes
No
Will The Dog Be Allowed in the Pool? (Required if you answered Yes to Outdoor Swimming Pool)
Yes
No
Do You Have Playground Equipment?
*
Yes
No
Do You have Stairs Outside? Type? Height?
*
Do You Have Excercise Equipment The Dog Will Be Exposed To?
*
Yes
No
Does Your Neighbors' Yard Adjoin Yours? Type Of Fence Divider?
*
Do Your Neighbors' Have Any Of The Following? (Check All That Apply)
Children
Dogs
Cats
Farm Animals
Location Of Your Residence?
*
Large City
Small Town
Residential Neighborhood
Farm
Rural Area
What Type Of Road/Street?
*
Major Hwy
Busy Road
Light Traffic
Residential
Country Road
Adopter Family Information
Pets You Currently Own?
*
(Check All That Apply)
Dog(s)
Cat(s)
Caged Animal(s)
None
Are They Spayed/Neutered?
Yes
No
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?
*
Yes
No
Are You Or Your Children Involved In Sports?
*
Yes
No
Will You Be Taking The Dog To Sporting Events?
*
Yes
No
Do You Have Children That Are Pushed In A Stroller?
*
Yes
No
Activity Level Of Household/Children?
*
Busy
Noisy
Moderate
Quiet
Myself
Myself And Significate Other
Do You Have Children In College That Will Be Home At Certain Times?
*
Yes
No
Do You Have Other Family Or Friends That Will Live In Your Home From Time To Time?
*
Yes
No
Do You Have Grandchildren That Will Be Visiting?
*
Yes
No
Is There Anyone That Lives In Your Home Or Visits, That Has Any Type Of Disability Or Handicap?
*
Yes
No
If Family Member, please explain?
Will The Dog Be A Companion For The Disabled/Handicapped Person?
*
Yes
No
Need 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?
*
Yes
No
Handicapped
Are You Or Any Member Of Your Family Allergic To Pets?
*
Yes
No
A Little
Have You Ever Had A Dog Trained Or Taken A Dog Through Training?
*
Yes
No
Tried
What Type Of Training Collars Have You Used?
*
Choke Chain
Buckle Collar
Harness
Prong Collar
Remote Collar
Invisible Fence Collar
None
Have You Ever House Broken A Dog Before?
*
Yes
No
Tried
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?
*
Level One(1) $5,800.00
Level Two(2) $7,800.00
Level Three(3) $9,800.00
Elite K-9(4) $13,000.00
Therapy Dog $15,000.00
Emotional Support Dog $17,500.00
Service Dog $20,000.00
Do All Members Of This Househould WANT This Dog?
*
Yes
No
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?
*
Yes
No
Please Provide Two Personal References and a Vet Reference?
*
Provide Any Additional Comments.
Application Completion
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