Little Buddies Adoption and Humane Society

Time In Your

Care

Neutered

Yes or No

Gets along with dogs

Yes or No

Wears ID

Yes or No

Your Household

Name(s) of each household adult ______________________________________________________

over age 18 ______________________________________________________

Occupation(s) of household adults _____________________________________________________

Are there any children under age 18 in the household? Yes 5 No 5

List the ages of all children under age 18 in the household: _________________________________

Have the children had animals before? Yes 5 No 5 Was this successful? Yes 5 No 5

If not, please explain. _________________________________________________________________________________

Has anyone in your household ever been convicted of a violent crime? Yes 5 No 5

If yes, please explain. _______________________________________________________________

Are there any problems with abuse of adults, children or animals in your household? Yes 5 No 5

If yes, please explain. _______________________________________________________________

Has anyone in your household ever been convicted of the abuse or neglect of any animal?

Yes 5 No 5 If yes, please explain. ___________________________________________

Name	Relationship	Phone	Address

Your Home

Address______________________________________________________ Apt. # ___________

City _______________________ State ________________________ Zip _____________

Home phone _____________________ Work Phone _________________________________

E-mail address ___________________ FAX _______________________________________

Do you own or rent your home? _____________________________________________________

Is your home a: 5 single home, 5 apartment, 5 duplex, 5 townhouse,

5 mobile home, 5 other _____________________

Are there any community restrictions to dogs? Yes 5 No 5

If yes, please explain. ___________________________________________________________

If you rent, do you have written permission from your landlord to have a dog? Yes 5 No 5

Landlord name _______________________________ Landlord phone ____________________

How long have you been at your present address? _______________________________________

Are you planning to move within the next 6 months? Yes 5 No 5

Will all of your companion animals go with you if you move? Yes 5 No 5

Is anyone in your home allergic to dogs? Yes 5 No 5

If yes, please explain. _________________________________________________________

Yard size ________________________ Do you have an invisible fence? Yes 5 No 5

Is your yard fenced? Yes 5 No 5 Height of fence: ___________________________

Do any of your dogs have any behavioral or dominance problems?

Yes 5 No 5 If yes, please explain: ___________________________________________

Do all of your dogs get along with each other? Yes 5 No 5

If no, please explain. _______________________________________________________________

Cats In Your Household:

How many cats are currently living in your household? ___________ Please list them here.

Do all of your cats get along with other cats? Yes 5 No 5

If no, please explain: ____________________________________________________________

Other Animals In Your Household:

Do you have any animals other than dogs or cats? Yes 5 No 5

If so, what type and how many? _________________________________________________________

Veterinary Care

Name of your veterinarian: ______________________________________________________

Address _______________________________________________________________________

Phone _______________________________________________________________________

Do all of your companion animals receive yearly veterinary visits? Yes 5 No 5

If no, please explain. _____________________________________________________________

Do all of your companion animals receive vaccinations as required? Yes 5 No 5

If no, please explain.______________________________________________________________

Name	Age at death	Cause of death

Please list all companion animals whom you have had within the past 10 years whom are no longer with you for reasons other than death:

Name	Reason for separation	Current location

Housebreaking

Housebreaking a dog/puppy requires knowledge about the best means to accomplish this, as well as a commitment of time and patience.

I agree to housebreak any dog/puppy, not already housebroken, who is adopted from Little Buddies. I agree to do this in an humane and accepted fashion. Yes 5 No 5

I agree to seek advice from my veterinarian and/or Little Buddies if I am having problems housebreaking any dog/puppy adopted from Little Buddies. Yes 5 No 5

I agree to provide any dog/puppy adopted from Little Buddies with regular outdoor bathroom breaks as needed by the dog/puppy. Yes 5 No 5

Socialization Classes For Dogs

All dogs should attend some type of socialization classes. The reasons for this include:

1. Improved human-dog bonding

2. Better companionship for humans

3. Prevention/elimination of dog behavioral problems

4. Decreased biting

5. Preventing dog from getting into dangerous situations

6. Increased likelihood that the dog will be gladly accepted at the park, kennel, and doggie daycare

7. Decreased chance that the dog will be given up or abandoned. Puppies who have graduated from

socialization classes are less than half as likely to be returned to a shelter as puppies who have not

had socialization classes.

I agree to strongly consider socialization classes for each and every dog adopted from Little Buddies.

Yes 5 No 5 If no, please explain. _________________________________________

I agree that any socialization class, to which I take a dog/puppy adopted from Little Buddies, should be humane, approved by my veterinarian and based upon positive reinforcement and not negative reinforcement. Yes5 No 5 If no, please explain. __________________________________ __________________________________________________________________________________

Financial Factors

Each companion animal will cost a household about $500.00 per year. Are you financially able to provide this for each of the companion animals whom you currently have, as well as for the new animal that you would like to adopt? Yes 5 No 5

Are you financially able and willing to provide annual checkups, vaccinations and ANY medical care necessary for each of the companion animals whom you currently have, as well as for the new animal that you would like to adopt? Yes 5 No 5

Giving Your Dog A Good Home

Dogs can live to be 10-20 years old depending on the breed. Can you commit to care for the dog you adopt for his/her entire life? Yes 5 No 5

How long are you willing to allow the new dog to adjust to his/her new home? ____________________

What will you do if your new dog does not get along with your present companion animals? ________

___________________________________________________________________________________

How long are you willing to allow the new dog to adjust to other animals in the home? _____________

If your dog gets lost, in addition to contacting Little Buddies, what steps will you take? ____________

___________________________________________________________________________________

Who will care for your dog if you go away? _______________________________________________

How will your new dog spend his/her days? (Circle everything that applies)

Indoors Outdoors Basement Garage Porch Yard Barn Locked in room Crated

Fenced yard Loose unfenced Tied outside Dog house Kennel run

How will your new dog spend his/her nights? (Circle everything that applies.)

Indoors Outdoors Basement Garage Porch Yard Barn Locked in room Crated

Kitchen Fenced yard Loose unfenced Tied outside Dog house Kennel run

Please describe the kind of dog that you are interested in adopting:

Age _____________ Size __________________ Breed ____________________________

Sex _____________ Reason for sex preference _____________________________________

Coloring ___________ Temperament _______________________________________________

Will he/she be a working dog? Yes 5 No 5 If so, what type of work? ___________________

Why do you want to adopt a dog? _______________________________________________________

__________________________________________________________________________________

Why do you like the breed/mix you are interested in? _______________________________________

Have you had this breed/mix before? Yes5 No 5

Acknowledgement

I/We acknowledge that all of the information provided in this application form is true and correct. I/We understand that any misrepresentation of fact may result in Little Buddies refusing adoption privileges to me/us. If my/our request is approved and later Little Buddies discovers that any of the information is not true or correct, Little Buddies reserves the right to remove the adopted dog from my/our home.

I also agree to allow Little Buddies to visit my/our home by appointment as part of our application process.

Signature of Applicant(s) ________________________________________________________________

_________________________________________________________________

Date of Application _____________________________________________________________________

Little Buddies Staff Signature ____________________________________________________________