Adoption Application Colville Pet Refuge

**Adoption Application**
**Colville Pet Refuge (CPR)**
The answers you give on this application will help us to find the best possible match between you and the dogs available though CPR. Please fill out the form completely and return to the address below. NOTE: If no phone number is given, this application will be discarded.
Your Name:		Home Phone: ( )
Address:		Alternate phone: ( )
City:	State:	Zip:	E-mail:
Best Time To Call:		Occupation:
Personal Reference/Name:		Phone: ( )
Do You Own Or Rent Your Home? (Rent) (Own)		If Rent, do you have landlord's permission to keep a dog? (YES) (NO)
Landlord's Name:		Landlord's Phone: ( )
Do You Live In: (House) (Apartment) (Trailer) (Condo) other:
How long at this address?		Do you have a fenced yard? (YES) (NO)
Fence Type: (Wood) (Chain Link) Other, please list:
Fencing completely encloses yard for dog? (YES) (NO)		In Feet, how high is fence?
If no fence, how will you handle dog's exercise and toilet duties? .
Do you have a separate kennel run? (YES) (NO)		List Height and Size:
How many adults in household?		How many Children?
Age and sex of children:
Are there any visitors to your home, human or animal, with which your new dog must get along? ____________________________________________________________ _____________________________________________________________________________
Do you own other dogs? (YES) (NO)		Are they Spayed/Neutered? (YES) (NO)
Give breed, sex and age of each:_______________________________________________ _________________________________________________________________________________
Do you own cats? (YES) (NO)		How Many?
Any other animals you own?_____________________________________________________ .
Do you have a regular veterinarian? (YES) (NO)
Name of veterinarian:		Phone: ( )
How many dogs have you owned in the past 5 years?
Give breed(s) and list if you still own dog:
If not, what happened to the dog:
Have you ever owned a dog before? (YES) (NO)
Why did you choose this breed? .
List all plans for this dog (Pet) (Guard) (Hunting) (Obedience) (Agility) Other:
Do you want to adopt: (Female) (Male) (No Preference)
Color Preference: (Black/White) (Red) (Copper) (Silver/Gray and White) (White) (No Preference) Other:
Where will dog spend the day? (loose indoors) (crate) (basement) (garage) (fenced yard) (loose outdoors) (tied up outside) (kennel run) other:

**Adoption Application Continued**
How many hours, on the average, will the dog spend alone?
Where will the dog spend the night? (loose indoors) (crate) (basement) (garage) (fenced yard) (loose outdoors) (tied up outside) (kennel run) other:
Are any family members allergic to dogs? (YES) (NO) Describe: .
Do all family members want to adopt a dog? (YES) (NO) If no, describe: .
Do you agree to license an adopted dog and give regular health care? (YES) (NO)
Do You understand that CPR requires all adopted dogs to be spayed or neutered? (YES) (NO)
Do you agree to contact CPR if you can no longer keep this dog? (YES) (NO)
Would you be willing to let a representative of CPR visit your home by appointment? (YES) (NO) If no, explain: .
How did you hear about CPR? .

All of the information I have given above is true and complete. I have also read and agree with CPR Terms of Adoption. Should an unneutered dog be placed with me, I agree to have it neutered within one month of adoption or by a date agreed upon by me and a representative of CPR. This dog will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection and medical care. I understand that CPR is a referral service and is not responsible for the accuracy of information received about the temperament, habits or physical condition of dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. Colville Pet Refuge is in no way Liable or responsible for any damage, accident or injury) resulting from the placement of a dog into my household.

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Applicant Signature Date