Atlantic County Canine - Adoption Application

Please Note: YOU MUST BE AT LEAST 18 YEARS OF AGE TO FILL OUT THIS APPLICATION. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED!!

* PLEASE MAKE SURE YOU COMPLETE.
** IF YOU ARE A FIRST TIME PET OWNER OR YOU DON'T HAVE A VET FOR YOUR PRESENT PET, YOU MUST COMPLETE.

 
*Name Of Pet You Are Interested In
ACC Contact Person
PERSONAL INFORMATION
*Name:
*Address:
*City: *State: *Zip:
*Phone
Day: Evening:
*E-mail:
FAMILY INFORMATION
Spouse
Child/Children
Ages
*Is everyone in your home in agreement to adopt this pet Yes No
*Are you aware that there is a set adoption donation Yes No
CURRENT PET INFORMATION
*Do you currently own any dogs? Yes No
Name(s)
Age(s)
Spayed or Neutered Yes No
If no, give reason why
*Do you currently own any cats? Yes No
Name(s)
Age(s)
Spayed or Neutered Yes No
If no, give reason why
*Did you ever give up a pet Yes No
If yes, give reason why
*Did you ever put a pet in a shelter Yes No
If yes, give reason why
VET INFORMATION
Vet Name:
Vet Address:
Vet Phone:
HOME INFORMATION
* Own Home Rent Home
LandLord Name
Address
LandLord Phone Number
Fenced In Yard (Height & Style)
PET INFORMATION
*Will Your New Pet Be A Lifetime Commitment Yes No
Where Do You Plan On Keeping Your New Pet
Where Exercised
Home During Day Yes No
Who Is Home
How many hours a day will pet be left alone
JOB INFORMATION
Employer
Employers Address
Name and Phone Number of two Personal References. Please include E-mail Address.

**Personal Reference #1
Name:
Phone:
Email:
Personal Reference #2
Name:
Phone:
Email:
COMMENT
State briefly why you want a pet
By checking the box below I further certify that the information I have provided on this form is true, correct, and accurate.