Saving Grace and Her Furry Friends 501(c) 3 Non-Profit Organization

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1 Saving Grace and Her Furry Friends 501(c) 3 Non-Profit Organization Scan and to: Stefanie savinggracefl@gmail.com Fax: (call to make sure someone is home before faxing) or mail to: Stefanie Miller 3931 SW 82 nd Terrace Davie, FL Make checks payable to Saving Grace and Her Furry Friends or via paypal to savinggracefl@gmail.com DOG Adoption Application Applicants Name: Name(s) or whom you live with: Age: Age: Phone (cell) Phone (hm) Address: City: State Zip Employer: Address: Phone Number: How did you hear about Saving Grace s Rescue? 1. Why do you want to adopt a dog? 2. What type of breed are you most interested in?

2 What do you know of this breed? Have you done research? Male Female Age range Hair type Activity Level Type of Activity Size 3. Where would the dog stay during the day? Indoor Outdoor Indoor/ Outdoor Do you crate your pets? Y or N If so, for how many hours at a time? 4. Do you have an enclosed yard? Yes No How tall is the fence? 5. Where will your dog sleep? 6. How long will the dog be alone? Where will he/she stay? 7. Who will be primarily responsible for the dog s care? Where would the dog stay when someone is home? Where will the dog stay when you are out of town? How will you and your family spend time with the dog? 8. Do all members of your household want a dog? Y or N If NO, Who? Why?

3 9. Do you know that dog require yearly vaccinations? Y or N Can you afford monthly heartworm preventative? Y or No Monthly flea/tick preventative? Y or N 10. Do you plan to walk & exercise your dog everyday? Y or N Which type of Activities? What is your lifestyle? (very active, loud/busy home, quiet, lots of people around, rarely have people over, travel often, lots of after school activities, couch potato, retired, longs, walks, running, etc.) There is no right or wrong answer, we are just determining if the particular dog you are interested in would fit into this lifestyle. The more details you provide the easier we will be able to see if it s a good fit. 11. How are you planning to obedience train your dog? 12. What will you do if your dog develops behavior problems? 13. Do you currently have a vet? Y or N May we contact them for reference? Name of Vet: Phone: Address: City State Zip

4 14. Do you understand that you will be sharing your life with a dog for years, who is totally dependent upon you for food, shelter, health and veterinary care. Are you willing and able to make this life-long commitment to a dog as a family member Have you ever surrendered to a shelter or given away your pet? If so, for what reasons? FAMILY INFORMATION 15. How many adults Children Ages in household? What is your living situation (have roommate(s), live at home with parents, live with a partner/engaged/married or live alone? 16. Do you have children visiting? How often? Ages 17. If you have pets currently, please list them below: Type of Pet Age Sex Spayed/Neutered? Indoor/Outdoor 18. Please list all animals you had in the past 5 years, not listed above. Type of animal Age Sex Spay/Neuter Indoor/Outdoor What happened?

5 19. Do you live in a House Townhouse Condo Apt Which best describes the area where you live? City Suburb Rural 20. Do you own rent Do you have a pet size, weight, # allowed limit where you live? Y or N If YES is what is it? Landlord Name: Phone: May we contact your landlord to confirm pets/sizes are permitted? Y or N 21. Would you agree to a home visit to ensure it is secure for the pet? Y or N 22. If something should happen to you where you are no longer able to care for your pet what provisions for their care have and would you make? May we contact them to verify that they would be willing to take over the total care for the lifetime of the pet? Y or N Name/number 1st PERSONAL REFERENCE: Name: Phone: hm: Mobile: Relationship:

6 2nd PERSONAL REFERENCE: Name: Phone: hm: Mobile: Relationship: I certify that all information in this application is true, and I understand that false information may void this application. I agree that upon adopting a pet from Saving Grace, I will agree and abide by their Adoption Agreement. Signature: Date

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