Viola Valley Dogs

Adoption Application

Pet Applying For:                     Date:

Applicant / Co-Applicant Information

Last Name:         First Name:         DOB:

Last Name:         First Name:         DOB:

Address:     Apt. #:

City:     State:     Zip:

Home Phone:     Cell Phone:

E-mail Address:

Home - Own     Rent         How Long Have You Lived at This Address:

Landlord Name:     Landlord Phone:

Family / Household Information

Number of Adults in Household:     Relationships:

Number of Children in Household:     Ages:

Why would you like to adopt an animal from us:

Employment Information

Employer:     Position Held:

Address:

City:     State:     Zip:

How Long Have You Been with this Employer:     Work Phone:

Pet Information

Have you had pets in the past or do you currently have pets? Please provide information below.

Have you ever given away or relinquished an animal to a shelter? Yes No

If yes, what were the circumstances:

Veterinarian Information

Veterinarian's Name:   Veterinarian's Phone:

References

1.        

                        (Name)                                                          (Relationship)                                    (Phone Number)

2.        

                 (Name)                                                             (Relationship)                                    (Phone Number)

3.        

                      (Name)                                                           (Relationship)                                    (Phone Number)

By signing below, I certify that the information I have given is true.  I understand that Viola Valley Dogs reserves the right to deny my application for any reason.  I further authorize the investigation of all statements in this application.

                                        (Applicant)                                                                                                                (Co-Applicant)

                                        (Date)                                                                                                                                (Date)

All applicants MUST agree to a home inspection prior to the approval of any application.