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:                                                                                                                                    

 Own Home:                     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 an animal away or relinquished an animal to a shelter?                                               

 If yes, what were the circumstances?                                                                                                      

 Veterinarian Information

Veterinarian’s Name:                                                        Veterinarian’s Phone:                                      

 References

Please list 3 personal references below.

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 truce.  I understand that Viola Valley Puppy Rescue 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.

Please copy and paste application in an e-mail and send to violadogs@yahoo.com

THANK YOU!!