What are
some
reasons
you would relinquish this dog back
to
the
E.C.D.P,
e.g.
human aggression, animal aggression, housetraining
problems, excessive chewing, separation anxiety, moving, having a baby, cannot afford any longer, etc.?
PREVIOUS
AND
CURRENT
PET
INFORMATION
Have
you ever
had
a pet:
Run
away
__
Get hit by a
car
Die
in
your care?
___
Kept
as
an
outdoor pet?
__
_
If
so,
please explain:
__________________________________
_
Have
you ever: Given/sold
an
animal
to
a family member Given/sold
an
animal
to
other person Given
an
animal
to
a rescue or other animal welfare society (please list the organization(s))?
__________________
_
Ifso,why?
_________________________________________
_
What
pets
do
you
currently
have
or
have
had
in
the
past
THREE
years
in
your
household?
Are your pets current on vaccinations (received within the last year)? Were previous pets taken
to
the vet annually?
Are your pets spayed/neutered? Were previous pets spayed/neutered?
If
no,
Please
explain why?
___
_
Who
is
your veterinarian?
_____________________________
_
Please
provide their address
and
phone number:
___________________________
_
Would the records
be
under another name other than the one provided on the front
ofthis
application?
_______
_
Wso,pleasepro~dethefullname:
________________________________
_
Do
you
have
other veterinarians that may have records for your current or past
pets?
If
so,
please provide their
name,
address
and
contact information:
HOUSEHOLD INFORMATION
Please
list
the
names
and
ages
of
all
people
living
in the
home
and
their relationship to
you
(Spouse/Partner/Roommate/Daughter)? Failure to /ully disclose this in/ormation will result in immediate adoption denial.
Name
and
Age:
_______________
_
Relationship:
________________
_
Name
and
Age:
_______________
_
Relationship:
________________
_
Name
and
Age:
_______________
_
Relationship:
________________
_
Name
and
Age:
_______________
___
Relationship:
________________
_
Name
and
Age:
_______________
_
Relationship:
________________
_
Name
and
Age:
_______________
_
Relationship:
________________
_
Do
children (not
in
the immediate family) ever visit your home?
_____
If
so,
how often:
_________
_
Age(s)
of
the children:
_____________
_
Does
anyone
in
the household
have
allergies
to
any kind
of
animals? If
YES,
have they consulted with their doctor about
getting
an
animal?
If
YES,
are they taking medication ?
______
_
Are
you
In
the
process
of
moving, or anticipate moving in the next few months?
Yes
____
No
____
_
If
you ever move,
have
you considered that another place may
not
allow pets? What will you do
if
this happens?
2
