Dog's Name(Required) Contact InformationName(Required) First Last Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Driver's License Number(Required) Spouse / Partner Name First Last Spouse / Partner Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Spouse / Partner PhoneSpouse / Partner Email Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Alt PhoneEmail(Required) Preferred Method of Contact(Required) Email Phone Employment InformationEmployer(Required) How long employed?(Required) Occupation(Required) Spouse/Partner Employer How long employed? Occupation Home InformationLiving Arrangements(Required) Rent Own Live with parents Are there children who live in or visit the home?(Required) Yes No How long have you lived at the above residence?(Required) Please list the names and ages of others living at your current residence.Are there restrictions on the size of dog where you live?(Required) Under 25 pounds Under 50 pounds No Restriction Do you have a fenced-in yard?(Required) Yes No Type and Height of Fence(Required) Please describe the activity level in your home(Required) Is anyone in your family allergic to animals(Required) Yes No Does everyone agree to adopting a dog?(Required) Yes No Animial CareWho will be the primary caretaker?(Required) Home many hours a day will the dog be left alone?(Required)Where will the dog be kept while you are not at home?(Required) Where will he/she sleep at night?(Required) What do you consider a reasonable adjustment period for your dog to become acclimated to his/her new home?(Required) Will you take the dog on daily walks?(Required) Yes No How long have you been thinking about adopting?(Required) What characteristics are you looking for in a dog?(Required) What do you require from your dog?(Required)What will you feed the dog and how often?(Required) Who will care for the dog when you are out of town?(Required) If you have to move, what will you do with the dog?(Required) List any reasons that you would have for giving up a dog(Required) In the event of an emergency, where will the dog go?(Required) Do you have any pets in the home currently?(Required) Yes No Please list current pets in your home(Required)NameBreedAgeSexYears OwnedSpayed/Neutered Add RemoveAre your current pets up-to-date on shots?(Required) Yes No Name of your current veterinarian(Required) First Last Veterinarian's phone number(Required)Name records are under(Required) First Last Please provide two personal references (non-family)(Required)NameRelationshipPhone Add RemoveI 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(Required) First Last Angelina WilsonAdoption Application06.02.2018