Animal Control
Adoption Form
Dog Description (attach Dog Acquisition and Information sheet) _________________________
Adopter’s Name _________________________________Date __________________________
Please Print
ID / Driver’s License # __________________________________________________________
Address _______________________________________________________________________
Mailing Address City State Zip
E-mail address _______________________________________________________________
Home Phone Number ___________________
Work Phone Number ____________________
Cell phone Number ____________________
Other Contact Number ____________________
Do you own or rent the property where the dog will be kept?
Owner Renter
If renting, the apartment owner must provide a letter (to be attached to this
form) acknowledging permission to keep pets in the residence and listing
stipulations regarding size or type of animal.
Required Agreements
_____ (Initial) The dog will be kept as my pet
_____ (Initial) Collar with rabies tag is required (Arkadelphia residents only)
_____ (Initial) Dog may not be sold, traded, or given away
_____ (Initial) Veterinarian Care, Food, Water, Shelter will be provided
Adopter Signature _____________________________________ Date ________________
Animal Control _______________________________________ Date _________________
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