Dog Adoption Application - Bark Avenue Foundation, Los Angeles CA Date* Date Format: MM slash DD slash YYYY Name of the dog you wish to adoptName* First Last Email* Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code In what type of home do you live?* House Apartment Condo/Townhouse Duplex/Triplex Mobile home Cottage/Bungalo Guest house Do you have permission from your landlord to have a dog?* Own - do not need landlord permission Rent - I have permission to have a dog Rent - I'm not sure about permission, I need to check. Do you have a yard? If Yes, please describe your yard enclosure including what material the fence/wall is made of, how high/low, # of gates and what kind of latch or lock the gates have. Is there a pool and is it enclosed?*How many hours a day will your dog be left without human companionship? During this time where will your dog be (inside loose, inside in a crate, inside with access to ousdie via doggie door, outside in yard only, etc)*Are any members of your household allergic to dogs?* Yes No Please list the name of each person living in your home. Please specify their relationship to you (spouse, parent, child, etc.) Anyone under 21 years old please specify their age.*Please list ALL pets that you CURRENTLY own. Include the following information: breed, age, gender, length of time in your care, indicate if they are or aren't spayed/neutered.*Please list ALL pets that ALL adult family members have PREVIOUSLY owned. Include the following information: breed, gender, indicate if they were or weren't spayed/neutered, length of time you owned them, what happened to them (if they died please indicate how, if you gave them away please indicate circumstances):*Have you ever allowed a pet to breed (get pregnant or impregnate another dog) ?* No - I have never allowed a pet to breed/get pregnant Yes - I purposley bred my pet(s) and had puppies/kittens Yes - I had a pet that accidentally got pregnant/got another dog pregnant Under what circumstances would you consider giving up/getting rid of your dog?* Moving/Move to aplace that doesn't allow dogs Divorce Marry/dating someone with allergies Vet bills/Dog becomes ill Planning to have/Had a baby Dog Behavior/Dog behaves badly (barking, destructive, accidents in the house, etc.) Dog doesn't get along well with current pets I wouldn't give my Dog up for any foreseeable reason Other Are you prepared to provide veterinary care for your dog for the rest of his/her life; including unexpected major illness, injury, disease which may become expensive?* Yes, I am prepared to spend whatever is necessary on veterinary care No, I am only willing to pay for routine annual veterinary care I am willing to spend money on veterinary care but only to a certain limit, I would consider euthanizing my dog if he/she requires an expensive treatment/surgery Are you prepared to take responsibility for this dog for the rest of his/her life, knowing that dogs have a life expectancy of at least 10-15 years?* Yes No Is there anything else you would like us to know?
