Fillable Providence Animal Control (City of Providence)

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Providence Animal Control (City of Providence)

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Providence Animal Control
DOG Adoption Application
Log # _______ Cage #: ________ Sex: _______ Today’s Date: ___________________
Breed: __________________________ Color: _______________________________
APPLICATION DOES NOT GUARANTEE APPROVAL
Name of Primary Caretaker/Legal Owner: ___________________________________________
Age: ____________ Occupation: ________________________________________________
Cell phone: __________________________ Work phone: _________________________
Address where pet will reside: ____________________________________________________
City: _______________________________ State: _________ Zip code: ______________
1) Please list everyone who will live with, care for or frequently visit this pet:
Gender
Will live with dog
Will visit
Will care for
Has met this dog
M / F
M / F
M / F
M / F
M / F
2) Please describe your living situation: (circle answer)
A) Single-family home Multi-family home Apartment Condo Duplex Dorm
B) Homeowner Renter Live with parents
3) How long have you lived at the above address? _________________
4) Homeowner/Landlord Name: _________________________ Phone #: _________________
(If you rent, a notarized letter of permission for THIS particular dog is required.)
5) How do you plan to exercise this dog? (circle all that apply)
Backyard play Leash walks Dog park Off-leash runs Doggie day care
Hiking Swimming Running Biking Other: ________________
6) Please describe your neighborhood: Rural City Quiet Noisy Busy street
7) Area of yard available to dog (approx. sq. ft. or dimensions): ______________________
8) Is the yard completely fenced? (Yes / No) Height: ___________ Stockade / Link / Invisible
9) Average number of hrs. dog will be home without people: ________ hrs. __________ days per wk
10) Where will the dog be kept when you are not home (ex. Work, outings)? (circle answer)
Loose in house Crate Confined to room/area of house Finished basement Unfinished basement
Outdoor kennel Garage/Shed Runner Fenced yard Tied in yard Other: _______________
11) Where will the dog be kept at night? (circle answer)
Loose in house Crate Confined to room/area of house Finished basement Unfinished basement
Outdoor kennel Garage/Shed Runner Fenced yard Tied in yard Other: _______________
12) Please describe all animals this dog will live with or frequently visit:
Species
Breed(s)
Age
Sex
Spayed/Neutered
Live together
Visit frequently
13) Please describe any past dogs you have owned:
Breed/Mixes
Spayed/Neutered
Age
Yrs. Owned
Where is dog now?
14) List any past veterinarians or veterinary clinics you took your pets to:
________________________________________________________________________________
15) Does anyone in your home have dog allergies? (Yes / No / Unsure )
The information I have provided is accurate and true to the best of my knowledge and I
authorize Providence Animal Control to verify any information I provided. It is in my
understanding that any false information will result in adoption refusal. I understand
Providence Animal Control may refuse any adoption.
__________________________________________ ______________________________________
Print Applicant Name Applicant Signature
STAFF USE ONLY
Approved by: _________________________ Date: _____________________
Denied by: ___________________________ Reason for denial: ____________________________
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Providence Animal Control (City of Providence)

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Completed 14 July 2020

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