Adoption Application

Dog's Name*

Contact Information

Name*

First Last

Date of Birth*

Driver's License Number*

Spouse / Partner Name

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Alt Phone

Email*

Preferred Method of Contact*

Email
Phone

Employment Information

Employer*

How long employed?*

Occupation*

Spouse/Partner Employer

How long employed?

Occupation

Home Information

Living Arrangements*

Rent
Own
Live with parents

Are there children who live in or visit the home?*

Yes
No

How long have you lived at the above residence?*

Please list the names and ages of others living at your current residence.

Are there restrictions on the size of dog where you live?*

Under 25 pounds
Under 50 pounds
No Restriction

Do you have a fenced-in yard?*

Yes
No

Type and Height of Fence*

Please describe the activity level in your home*

Is anyone in your family allergic to animals*

Yes
No

Does everyone agree to adopting a dog?*

Yes
No

Animial Care

Who will be the primary caretaker?*

Home many hours a day will the dog be left alone?*

Where will the dog be kept while you are not at home?*

Will he/she have access to the outside while you are away?*

Yes
No

Where will he/she sleep at night?*

What do you consider a reasonable adjustment period for your dog to become acclimated to his/her new home?*

Will you take the dog on daily walks?*

Yes
No

How long have you been thinking about adopting?*

What characteristics are you looking for in a dog?*

What do you require from your dog?*

What will you feed the dog and how often?*

Who will care for the dog when you are out of town?*

If you have to move, what will you do with the dog?*

List any reasons that you would have for giving up a dog*

In the event of an emergency, where will the dog go?*

Do you have any pets in the home currently?*

Yes
No

Please list current pets in your home*

Name	Breed	Age	Sex	Years Owned	Spayed/Neutered

Are your current pets up-to-date on shots?*

Yes
No

Name of your current veterinarian*

First Last

Veterinarian's phone number*

Name records are under*

First Last

Please provide two personal references (non-family)*

Name	Relationship	Phone

I understand a Kibblez of Love representative may visit my home for a home inspection before my adoption application is approved. I understand that if I am approved for adoption, I will also need to carefully read the "Adoption Contract" which is a separate document from this "Adoption Application." The Adoption Contract represents the legal contract between adopter and Kibblez of Love. I understand that if I am approved to adopt an animal, I must review, agree, and sign the Adoption Contract before I can take my new animal home. I have read this application in its entirety, and I agree that all statements contained in this document are made by me, and are truthful. I make this statement under penalty of perjury under the laws of the state of Florida.

Digital Signature*

First Last