Dog
Application
Please answer every question (enter n/a if question does not apply to you)
Are you applying to:
Adopt
Foster
Dog's Name/Breed:
Your Name:
Address:
City:
State:
NY
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP:
Home Phone:
Work Phone:
Occupation:
Employer:
Email Address:
Driver's License Number:
How many adults in household?:
1
2
3
4
5
6
7
8
9
Number of children in household:
0
1
2
3
4
5
6
7
8
9
Children's Ages:
All adults in agreement about adopting?:
Yes
No
Who will be responsible for the
pet?:
If this dog will be a gift, who
is it for?:
Is anyone in household allergic
to pets?:
Yes
No
Max # hours pet will be left
alone daily:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Are you moving in the next 12
Months?:
Yes
No
Do you own or rent your home?:
Own
Rent
If renting, name and number of
landlord:
Where will your dog be kept?:
If yard is fenced, what type of fence?:
What training/activities will
you provide?
Current dog breed(s) gender(s)
& age(s):
Why do you want another dog?:
If you have cats, list age of
each:
Where did you get your pets?:
Are all pets spayed/neutered?:
Yes
No
Are all pet(s) vaccinations up
to date?:
Yes
No
If not, why?:
Do they get along with other
animals?:
Have you had other pets in last
5 years?:
Yes
No
For how long/what happened to
them?:
Your veterinarian(s) name and
phone #:
Have you tried to adopt in last
12 mo?:
Yes
No
Will you agree to a home visit
by ACPR?:
Yes
No
By submitting this application,
I hereby certify that all answers I gave are true to the best of my
knowledge. I understand that ACPR
may accept or deny any request.