Dog's Name* Contact InformationName* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Driver's License Number* Spouse / Partner Name First Last Spouse / Partner Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* 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* Email Phone Employment InformationEmployer* How long employed?* Occupation* Spouse/Partner Employer How long employed? Occupation Home InformationLiving 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 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?* 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*NameBreedAgeSexYears OwnedSpayed/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)*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