Adoption App AKKR

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Adoption App AKKR Powered By Docstoc
					                                            ANIMAL KINGDOM KENNEL
                                                Adoption Application
17826 Lappans Road                               www.akkennel.com                                       301-582-3353
Fairplay, MD 21733                             jamie@akkennel.com                                   Fax 1-866-840-6717

This is an application for: __________________________________________________________________________

Applicant’s Full Name: _________________________________________ Age: ______________________________

Work schedule (circle all the apply): Full time/Part time, Days/Nights, Commute/work from home, Retired

Co-Applicant’s Full Name: _______________________________________Age: _____________________________

Relationship : ____________________________________________________________

Work schedule (circle all the apply): Full time/Part time, Days/Nights, Commute/work from home, Retired

Street Address: ___________________________________________________________________________________

City: _________________________ State: ___________________ Zip: ________________________________

Home Phone: __________________________________              Cell Phone: ________________________________
Work Phone: __________________________________

Email(s): __________________________________________________________________________________

How many adults reside in your household? ____________________
Are they supportive of this adoption? YES/NO
Ages of children living at home:



Have the children ever lived with animals before? YES/NO/N-A
If so what types:


Whose responsibility would the animal’s care be? _______________________________________________________

Approximately how many hours would the animal be left alone per day? _____________________________________

Who would care for the animal when the family leaves town? ______________________________________________
Are you willing/able to hire a pet sitter or boarding kennel if necessary (circle one)? YES NO

Vet’s Name: _____________________________________________________________________________________
Address: ________________________________________________________________________________________
Phone Number: __________________________________________________________________________________

Have you ever owned an animal before (circle one)?YES       NO

Please list the pets you have owned, if they are no longer living with you please explain why (please be neat):

1-

2-
3-

4-

5-
(Need more room? Use the back!)

Do you currently OWN or RENT your home? ___________________
If you RENT, Please fill out the following:
        Leasing Office Manager’s Name:
        Phone Number to Leasing Office:
        Hours they are open:
        Pet deposit? YES/NO       Amount of Deposit: $_________________

How long have your lived at this current address? _____________________________

What type of home most accurately describes yours (circle all that apply)?
Single Family Home         Apartment/Condo                 Townhouse                          Farm/Acreage

Do you have a fenced-in yard? (dogs only) YES               NO
      If YES, how high and what is it made of?

        If NO, how do you plan to exercise your dog and for how many hours per day?



Have you ever adopted an animal before? YES NO
If YES, please list the animals by name/species and the organizations’ name and phone number(s):
1-

2-

3-

(Need more room? Use the back of THIS sheet!)

Do you understand that your new pet will: (circle one)
1-Need to be checked annually for Heartworm and
               put on monthly heartworm preventative (cats too)? ….................................YES          NO
2-Require routine and emergency vet care, including dental work throughout it's life?...... YES                 NO
3-Need weekly grooming at home, including brushing, nails, and ear cleaning?................ YES                NO
4-Need to go outside a minimum of 3 times per day,
      equaling approx. 3 hours per day (dogs only)? ….................................................... YES   NO
5-Need to live inside your home and be an active part of the family (cats too)?................. YES            NO

Do you understand: (circle one):
1-You could pay $1200 per year for your pets’ food and routine vet care? ….................... YES              NO
2-If you add up the financial costs of owning a pet it can add
        up to over $10,000.00 for the animal’s entire lifetime? …....................................... YES    NO
Do you agree that before you adopt from us: (circle one):
1-You will pay an adoption fee and be required to sign a legal and binding
       Adoption Contract? ….............................................................................................. YES NO
2-You will be required to spay/neuter the pet you adopt from us,
       unless we’ve already done it? ….............................................................................. YES NO
3-You will be required to return the pet that you adopt from us if you cannot keep
       them at any point in their lifetime and you will not be able to give
               them away or adopt them to someone else? …......................................... YES NO
4-Are you willing to care for and pay for this animal through its old age
               and subsequent death? ….............................................................................. YES NO

When do you consider it necessary to euthanize an animal (use back if you need more room)?


Have you ever given up an animal, for any reason? (circle one)    YES NO
If YES, where/who was the pet given to? (For more than one pet please use the back side)
       Name:
       Phone Number:
Why was the pet given up?
What ultimately happened to the animal?

Have you ever been accused of/charged with/convicted of any type of abuse (i.e. animal, child, spousal, etc.)?
YES NO
Important: We DO check this question with the proper authorities, your signature on this document gives us the legal
ability to perform a background check on your criminal record and with the SPCA in your area. AKKR reserves the
right to refuse adoption to anyone based on prior crimes or accusations, regardless of outcome.

Next-door Neighbor References:
1) Name:
Phone number:
Relationship with you:
Number of years known:

2) Name:
Phone number:
Relationship with you:
Number of years known:

All the information I have provided on this application is, to the best of my knowledge, true and complete. I understand
that falsifying information on this application, or at any other time during the adoption process, disqualifies me from
adopting from the AKKR for my entire lifetime and that AKKR will keep records on denied applicants. I am aware that
submitting my application does not guarantee that I will receive approval to adopt a from AKKR and that AKKR
reserves the right to reject any applicant at any time during the adoption process, for any reason.

With the submission of this application form, I am authorizing AKKR to contact my veterinarian to discuss my
veterinary records and standing with their office as well as perform the necessary criminal and background checks to
ensure the safety of the adoptive pet.

Signature(s): _____________________________________________________ Date: ________________________

Please print your full name(s): ___________________________________________________________________
               My signature, electronic or physical, represents my confirmation of the statements above.

				
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posted:11/21/2010
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