1. Applicant(s) Contact Information:(please fill out for the adults in the household) Adopter 1 Name: Adopter 2 Name: E-mail Address: Physical Address: Phone Number: Best time to be reached? -- Please select -- Morning Afternoon Evening Weekends How did hear about Viva? -- Please select -- Google Yahoo Link from a website Word of mouth Other 2. Applicant(s) Basic Information Adopter1 Occupation: Employer: Average Work Hours: Hobbies: Adopter2 Occupation: Employer: Average Work Hours: Hobbies: Reference 1 (name,number, and relation): Reference 2 (name,number, and relation): Veteranarian Reference: 3. Home and Living Situation: Please describe the type of home you live in: Do you rent or own your home? Rent Own If you rent, what is the pet policy?: Does your home have a fenced in area? If so, describe fence material and height: If no fenced in area, how will you be able to safely excercise your pet daily?: How many hours on average will your dog be left alone?: Where will your dog or puppy be left while you are away?: Where will your dog or puppy be when you are home?: Please list age and gender of all household members: Are there any children under 8 regularly visiting your home? -- Please select -- Yes No Sometimes Do you plan on having children within the next 5 to 10 years? -- Please select -- Yes No 4. Past Pets & Future Accomodations Please list current animal species/breed/age/gender in your home: Have you ever surrendered a pet to a shelter?: -- Please select -- Yes No Have you ever had to give up a pet for any reason? if so, why? and what happened to the pet? If in a relationship, what would happen if you were to get a divorce or seperate?: What would happen if you had to move unexpectedly?: Do you plan on moving out of the state in the next 12 months?: -- Please select -- Yes No Do you plan to move into a different home within New Mexico in the next 3 months?: -- Please select -- Yes No Would you consider enlisting the help of a trainer or behaviorist for behavioral problems befor surrendering your dog?: -- Please select -- Yes No Are you prepared for any unexpected veterinary expenses that may arise in the lifetime of your pet?: -- Please select -- Yes No 5.Looking to Adopt Dog Name(s) I am looking to adopt: Please describe all the reason why you are looking to adopt a new dog. (please understand that the dog you may be interested in may not be a good match or already be pending adoption. We will recommend a dog or puppy based on your preferences): What training and personality type are you looking for in a new dog?: What is the most important factor you are looking for in a prospective pet?: Does every adult in the household agree to the adoption of this pet?: -- Please select -- Yes No Does anyone in the home have allergies to pets?: -- Please select -- Yes No What type of food do you plan to feed your pet: Are you open to crate using/training your pet?: -- Please select -- Yes No 6.My and/or my family's activitywould like a dog to participate in: Do you enjoy your dog sleeping at your feet while you watch tv?: -- Please select -- Yes No How often will you walk your dog?: Not often Once or twice a day A few times a week How often will you jog your dog?: Not often Once or twice a day A few times a week Would you take your dog camping?: -- Please select -- Yes No Maybe Would you take your dog to dog-friendly parks, stores, or cafes?: -- Please select -- Yes No Maybe Will your dog participate in doggie sports such as agility, hunting, or sporting?: -- Please select -- Yes No Maybe 7.The Type of Dog I am Looking For What size of dog are you looking for? -- Please select -- Toy Size Small (up to 25 lbs) Medium (25-60 lbs) Large (60-100 lbs) Giant (100 lbs+) Any size What type of coat? -- Please select -- Short Haired Medium Length Coat Long & Fluffy Low Shedding (such as poodle) No preference What type of breed? -- Please select -- Bully type breed Non-bully type breed No preference Energy type? -- Please select -- Low energy Medium energy High energy (great for active people) No preference Must be good with: -- Please select -- Other dogs in the home Cats in the home Birds/rabbits etc. Livestocks No Preference I am open to: -- Please select -- Adopting an "only dog" Adopting a special needs pet No Preference 8.Please complete the application by filling out the following: Viva conducts a home visit prior to adoption, do you agree to participate in a home visit ?: -- Please select -- Yes No By typing your name in this box, you are agreeing to digitally sign this application and testify that the above information is true to your knowledge. Signed by: Date: Please be aware that an application does not guarantee adoption of one or any of our adoptables. We do our best to ensure that each animal is placed in a well matched environment. In the event that the animal you are interested in adopting either is not a good match for your needs or is currently pending adoption with someone else we will do our best to refer other well matched animals based on your preferences. Unfortunately, some applications will not be approved to adopt. Would you like to be recommended another pet should the pet you applied for be unavailable? -- Please select -- Yes No Your comments:
