ࡱ> ` =bjbjss .50000 <Ly<x $ $ $ $$,0;;;;;;;$/=h?<5$$55< $ $3<:::58 $ $;:5;::: $ vB105:;I<0y<:!@5 !@:!@:23^:{3L3A222<<:222y<5555D Pet Point _______DNA ________Other Shelter _________Animal Wanted___________ CHELSEA BAILEY BUTTE-SILVER BOW ANIMAL SHELTER PEOPLE AND DOGS PROFILE A dog is the only thing on earth that loves you more than it loves itself ________Josh Billings Date _____________________ Shelter Employee _______________ The information you provide will help us help you find the best match for you and family. Please fill out application completely YOU AND YOUR FAMILY Adoption is a very serious commitment of your time and money. We take adoption very seriously as should you! It will alter your life as well as the dogs life. Are you very certain you are ready and responsible enough to take care of another life? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Please list all adults living in the house-hold Name ______________________________ Are you 18 years or older?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Name ___________________________________ Name ______________________________________ Street address _________________________ City __________________ State _____________ Zip _______ Home phone ____________________ Place of work ____________________ Work phone ______________ Email ___________________________________________________________________________________ Type of housing (check all that apply):  FORMCHECKBOX  Own  FORMCHECKBOX  Rent  FORMCHECKBOX  Live with parents  FORMCHECKBOX  Military  FORMCHECKBOX  House  FORMCHECKBOX  Condo  FORMCHECKBOX  Apartment  FORMCHECKBOX  Mobile Length of time at current address: Months _____________ Years _____________ Landlord name ____________________________________________ Phone __________________________ Name of friend or relative not living with you ____________________________ Phone _________________ Veterinarian Reference (past or present)___________________________Phone________________________ Name Vet. Account is under _________________________________________________________________ Adults living in the household:  FORMCHECKBOX  Men, how many? _____________  FORMCHECKBOX  Women, how many? ____________ Children living in the house hold:  FORMCHECKBOX  Boys, how many? __________ Ages: ____________________________  FORMCHECKBOX  Girls, how many? __________ Ages: ____________________________ Is there anyone in the household allergic to pets?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Explain _____________________________ Is there anyone in the household nervous or unsure of dogs?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Explain ____________________ Do you have children in the neighborhood that visit?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Ages: ___________________________ PET HISTORY - EXPERIENCE Current Pets Type Name Age Sex Spayed/Neutered Where is the pet kept? 1. ______________ ______________ ________ _______  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  In  FORMCHECKBOX  Out  FORMCHECKBOX  Both How long have you owned this pet? ______________________ 2. ______________ ______________ ________ _______  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  In  FORMCHECKBOX  Out  FORMCHECKBOX  Both How long have you owned this pet? _________________________ Past Pets Type Name Spayed/Neutered Where was the pet kept? How long owned? 1. _____________ __________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  In  FORMCHECKBOX  Out  FORMCHECKBOX  Both ______________ What happened to this pet? __________________________________________________________________ 2. _____________ __________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  In  FORMCHECKBOX  Out  FORMCHECKBOX  Both ______________ What happened to this pet? __________________________________________________________________ Whats your dog experience?  FORMCHECKBOX  First-time owner  FORMCHECKBOX  Have had one or two  FORMCHECKBOX  Knowledgeable & Experienced Why do you want to adopt this dog? __________________________________________________________ What will you do with the dog when you leave town? ____________________________________________ What will you do with the dog when you move? _________________________________________________ If traveling with me, the dog would be:  FORMCHECKBOX  Inside the car  FORMCHECKBOX  Back of pick-up truck  FORMCHECKBOX  Crate  FORMCHECKBOX  None, would stay home If the dog becomes sick or injured will you take it to the vet immediately?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Depends When I relate to dogs I tend to be:  FORMCHECKBOX  Strict, demanding, a real leader (dog sits for treat)  FORMCHECKBOX  Lenient, (dog gets treat because theyre cute)  FORMCHECKBOX  Demanding or lenient, depending on the dog and situation Will you be crate-training the dog?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If you returned home to find that the dog had chewed your favorite shoes or urinated on the floor what would you do? _________________________________________________________________________________ If the dog needs professional training, are you willing and financially able to enroll the dog in a group class or with a private in-home trainer?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Who will be the primary care-taker of this dog? __________________________________________________ Have you ever been denied at another Animal Shelter Yes  FORMCHECKBOX  No  FORMCHECKBOX  If so, what shelter and circumstances: _______________________________________________________________________________________ YOUR HOUSEHOLD Time away from the animal:  FORMCHECKBOX  Home all day  FORMCHECKBOX  Out part-time  FORMCHECKBOX  Away 7 10 hours daily Where will the dog be kept during the day? _______________________ At night: _____________________ Where will the dog be kept when you are not at home? ___________________________________________ Household activity level:  FORMCHECKBOX  Quiet  FORMCHECKBOX  Active  FORMCHECKBOX  Very active Availability to exercise the dog:  FORMCHECKBOX  Minimal exercise during week/lots of exercise on weekends  FORMCHECKBOX  Would go running daily with me  FORMCHECKBOX  Long morning and evening walks  FORMCHECKBOX  Three 15-minute walks a day Do you have a fenced yard?  FORMCHECKBOX  Yes  FORMCHECKBOX  No (please be honest, if you dont have a fenced yard its o.k., certain dogs definitely need a fenced yard.) If yes, type of fencing ______________ How high?______________ Is it secure? ______________________ Do you have a kennel or run?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Is it covered?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Do you plan on having a tie-out or cable run for the dog?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, type ____________________ HOPES AND EXPECTATIONS Breed Mix/Name __________________________________Color/s _________________________________ Size:  FORMCHECKBOX  0-10 lbs  FORMCHECKBOX  10-30 lbs.  FORMCHECKBOX  30-55 lbs  FORMCHECKBOX  55-85 lbs.  FORMCHECKBOX  85-100 lbs.  FORMCHECKBOX  100 & Up Age:  FORMCHECKBOX  8-16 weeks  FORMCHECKBOX  4-12 months  FORMCHECKBOX  1-3 years  FORMCHECKBOX  3-7 years  FORMCHECKBOX  8 & Up (Seasoned veterans, like Albert) Coat:  FORMCHECKBOX  Short  FORMCHECKBOX  Medium  FORMCHECKBOX  Long  FORMCHECKBOX  No preference Sex:  FORMCHECKBOX  Male  FORMCHECKBOX Female  FORMCHECKBOX  No preference Temperament and Activity level (check all that apply)  FORMCHECKBOX  Zippy, high energy, puppy like  FORMCHECKBOX  Mellow, easy going  FORMCHECKBOX  A lap dog  FORMCHECKBOX  Very affectionate  FORMCHECKBOX  A total kissy face  FORMCHECKBOX  Responsive  FORMCHECKBOX  Independent  FORMCHECKBOX  Vocal, talkative  FORMCHECKBOX  Quiet  FORMCHECKBOX  Likes kids  FORMCHECKBOX  Protective  FORMCHECKBOX  Special needs  FORMCHECKBOX  Other: ____________________  FORMCHECKBOX  Likes other animals, Type ____________________ Training:  FORMCHECKBOX  Has none  FORMCHECKBOX  Is housebroken  FORMCHECKBOX  Has some obedience training  FORMCHECKBOX  Is fully trained I prefer a dog whose energy level is:  FORMCHECKBOX  High  FORMCHECKBOX  Medium  FORMCHECKBOX  Low  FORMCHECKBOX  Couch potato I prefer a dog that:  FORMCHECKBOX  Will enjoy with me on leash  FORMCHECKBOX  Will enjoy with me on or off leash  FORMCHECKBOX  Will run, jog or hike with me  FORMCHECKBOX  Will exercise itself in our yard  FORMCHECKBOX  Requires only enough exercise to do its business outside Reason for wanting this dog: (check all that apply)  FORMCHECKBOX  Gift  FORMCHECKBOX  Watchdog  FORMCHECKBOX  Companion  FORMCHECKBOX  Companion for other pet  FORMCHECKBOX  Worker  FORMCHECKBOX  Hunter  FORMCHECKBOX  Other: ____________________ What personality traits are you looking for in your dog? ___________________________________________ ________________________________________________________________________________________ Dog habits I just cant tolerate are: ____________________________________________________________ ________________________________________________________________________________________ I would like more information about: __________________________________________________________ Example: dog to dog intro, housetraining, crate-training, identification, vaccinations etc. It sometimes takes a dog longer to adjust to a home that already has resident kids, dogs and cats. In some cases the new dog and other animals may never bond, only tolerate each other. How will you handle this? _______________________________________________________________________________________ RELEASE AND AGREEMENT I certify that the information I have given is true, and I authorize the CBBSB Animal Shelter to contact veterinarians, landlords and references to investigate all statements in this application, and to do follow-up property checks. Signature _________________________________________________ Date __________________________ STAFF USE ONLY Pending Adoption:  FORMCHECKBOX  Yes, Date ___________  FORMCHECKBOX  No  FORMCHECKBOX  Keep on File Landlord Permission:  FORMCHECKBOX  Obtained, Date ____________  FORMCHECKBOX  Denied Parental Permission:  FORMCHECKBOX  Obtained, Must be in Person, Date ____________  FORMCHECKBOX  Denied Potential adopters have brought currently owned dogs to meet their potential new dog in our meet and greet park:  FORMCHECKBOX  Yes  FORMCHECKBOX  No I have reviewed the following dog-related issues with the potential adopter:  FORMCHECKBOX  Dog/dog intro.  FORMCHECKBOX  Vaccinations  FORMCHECKBOX  Dogs and children  FORMCHECKBOX  Explained any and all  FORMCHECKBOX  Dog/cat intro.  FORMCHECKBOX  Age at which puppy can go outside  FORMCHECKBOX  Separation Anxiety treatments and surgeries FORMCHECKBOX  House training issues  FORMCHECKBOX  Identification, lost and found  FORMCHECKBOX  Food and nutrition animal has had  FORMCHECKBOX  Dogs and change  FORMCHECKBOX  Providing chew toys  FORMCHECKBOX  Behavior Helpline call us with any  FORMCHECKBOX  Crate-training  FORMCHECKBOX  Destructive behavior questions or problems!!!!! 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