Dog's Name*Contact InformationName* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Driver's License Number*Spouse / Partner Name First Last Spouse / Partner Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alt PhoneEmail* Preferred Method of Contact*EmailPhoneEmployment InformationEmployer*How long employed?*Occupation*Spouse/Partner EmployerHow long employed?OccupationHome InformationLiving Arrangements*RentOwnLive with parentsAre there children who live in or visit the home?*YesNoHow 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 poundsUnder 50 poundsNo RestrictionDo you have a fenced-in yard?*YesNoType and Height of Fence*Please describe the activity level in your home*Is anyone in your family allergic to animals*YesNoDoes everyone agree to adopting a dog?*YesNoAnimial CareWho 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?*YesNoWhere 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?*YesNoHow 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?*YesNoPlease list current pets in your home*NameBreedAgeSexYears OwnedSpayed/Neutered Are your current pets up-to-date on shots?*YesNoName of your current veterinarian* First Last Veterinarian's phone number*Name records are under* First Last Please provide two personal references (non-family)*NameRelationshipPhone 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 Angelina WilsonAdoption Application06.02.2018