Name
Address
Home Phone
Work
Phone
Cell
Phone
E-mail
Date of Birth
Employer
Occupation of person supporting pet
If
employed, how many hours a week?
Name, and Address of your current or past veterinarian
Veterinarian's Phone
Which dog would you like to adopt?
Role of new pet :(check all that apply) House pet
List
names and ages of those in your household:
Have
you surrendered an animal to a shelter, Humane Society, friend or animal control?
Yes
No
Not to STARS
If
yes, please explain:
Please
list names, ages, and breeds of current pets:
What heartworm prevention do you use?
Do
you?
Rent an
apartment
Rent a house
Own
your residence
If
you rent, does your landlord permit pets?
N/A
Yes
No
Is
your yard fenced?
Yes
No
If yes, what type?
Where
will you keep your pet during the day?
Where
will you keep your pet during the night?
Please
Enter any comments
I agree that, if allowed to adopt, I will not hold STARS of Amelia
liable for any direct or consequential damage arising from the
adoption. I agree that if I must give up this pet for any reason it
will be returned to Stars of Amelia. I agree to follow up on all
vaccinations as recommended by my veterinarian. I agree to give this
pet 2 months to adjust to its new home. I agree to work with a Behavior
Counselor should the pet develop behavior problems. I agree to allow
follow-up calls by Stars of Amelia on the new pets progress.
We do our very best to place only healthy animals for
adoption, but animals with unknown backgrounds can become sick. If this
occurs you have the option of returning the pet to us or having it
treated at your own expense by your veterinarian. If you choose to
return the animal, NO REFUND
will be given.
I certify that all information I have given is true,
and that false information may result in nullifying this adoption.
You must agree to the above terms
to submit an application.
I
Agree
