ADOPTION APPLICATION FORM

Name of the animal you wish to adopt:

PERSONAL INFORMATION

Name of the person interested in adopting:

Age:

Occupation:

Address:

Home phone:

Work phone:

Mobile phone:

FAMILY

How many members compose your family?Ages:

Who authorizes the adoption of the animal? (Mother, father, guardian, etc)

Are all the family members aware of the intention of adopting a domestic animal?

Do they agree? Yes___ No___ Who? _____ Reason why? ______

While the family or any of the family members isat home: where would it be staying?

Is anyone in your family allergic?

What would happen if someone develops an allergic reaction with the animal?

Are you planning to have children?

What would happen if you or your partner gets pregnant?

PET HISTORY

Have you ever had pets before?

What animal was it?

How long did it live with you?

Where is that pet now?

Why?

Has it been given the required vaccines?

What vaccines have been applied to it?

Howoften did it get the vaccines applied?

Did it get anti-parasite treatment?

How often did it get anti-parasite treatment?

Did it have puppies?

Yes____ No____ Why?

ACTIVITY/SPACE

Doy you have a garden or a back yard? Specify

If you live in an apartment: Do you have neighbours who own pets?

What kind of activities are you planning to do with your dog?

Where would it sleep?

How many hours in the day would it be alone?

While there is no one home: where would it be staying?

Do you own a house or do you rent a house?

What would happen if you have to move to another city/ state/country?

Who would take the dog for a walk?

Why would he or she be in charge of taking the dog for a walk?

Are you aware of the fixed costs that having a dog implies? (Give an estimate)

What kind of dog are you looking for?

Why?

What kind of floor do you have at home? Tile, carpet or other?

Are you willing to give your dog an adjustment period so that it can learn where to go to the bathroom and adapt itself to the family?

Why have you decided to adopt a dog or a cat?

ADDITIONAL COMENTS

  • This form does not represent a commitment to any of the parties involved.

GEPDA requires a donation between 250 and 400 USD, according to each case

that is used on veterinarian expenses for the animal

you are adopting as well as others.