Date        

Appl. Submittal Time        

Name of dog/puppy to adopt (if known)   

Would you like us to provide suggestions for appropriate dogs to adopt?       Yes    No    Not Sure

Applicant Name        

Street Address        

City/State/Zip Code      

Home Phone              Work Phone

Cell Phone   Email that you regularly check

Why do you want a dog?      

Gender Preference         Male    Female    No Preference    

Size Preference (check all that apply)       

        Extra small (under 10 - 15 lbs)   Small (15 - 30 lbs)   Medium (30 - 60 lbs)

        Large (60 - 90 lbs)                 Giant (90 lbs or more)   No preference

Comments   

Age Preference              Between ages

No Preference

Breed Preference 

Indicate any breeds you do not prefer

What breed(s)/ type(s) of dogs have you had responsibility for as the primary caregiver, and how long did you have each of them?

Pets you have at home

Name                      Species/Breed             Age   Gender  Current Vaccines  Spayed/Neutered  Where is pet kept during day?

Veterinarian's Contact Information

Name   

Street Address   

City/State/Zip Code

Office Phone

Number of people in household, including yourself      

List children in household and age  

Who will be the dog's primary caregiver?

Age of primary caregiver      

Do you live in a town, suburb, or rural area?     Town     City      Rural    

Housing     House     Condominium     Apartment     Mobile Home  

Do you have a completely fenced yard?             Yes*        No

        * If yes, please complete information below

        Approximate area (sq ft)        Height   4 feet high

                                                                                      6 feet high

                                                                                      Other height (please specify)

Will the dog primarily be an indoor or outdoor dog?               Indoor    Outdoor     Both       

Where will your dog spend his/her time when you're not home?

             Inside (describe location)

        Outside (describe location and shelter)

        Other (please describe)

Where will your dog spend his/her time when you're sleeping?

             Inside (describe location)

        Outside (describe location and shelter)

        Both/Other (please describe)

Do you need a dog who is able to be alone       4 hours or less per day  4 - 8 hours per day  

                                                          8 - 10 hours per day     10 - 12 hours per day  

                               Comments

I have visitors over:

    all the time -- I installed a revolving door 

    a lot 

    sometimes - I have occasional friends and family over  

    rarely - I don't even know if my doorbell works

     Other

How outgoing and social do you want your dog to be with other people?

    s/he is a "social butterfly" -- they want to say hi to everyone  

    s/he is outgoing -- they say hi to people but returns and lays by my side  

    s/he is more reserved -- they go to say hi to people if directed but perfectly content only with my attention  

    doesn't matter  

  Comments

Do you want a dog who likes to exercise:

    hardly at all - "couch potato"  

    moderately - 30 - 40 minute walk per day, playing fetch, etc.  

    a lot, a running/hiking partner  

    Other (please describe)  

Do you mind house training a dog?     

    No    Yes (understand any dog may have an accident or two while adjusting to a new environment)

Are you comfortable doing training with your dog to improve manners such as jumping, stealing food, and pulling on the leash, etc.?  

Yes  No

How much training are you willing to do?   

       Do not want to do training; need a dog that’s already trained  

    Willing to do some training  

    Willing to do a lot of training  

How much do you expect to spend yearly for the care of your dog, including food, medical care, boarding, grooming, toys, heartworm & flea control, etc.?  $ per year

Is it OK to conduct a scheduled home visit BEFORE the adoption takes place?        Yes  No

Is it OK to conduct a scheduled home visit AFTER the adoption takes place?        Yes  No

By indicating my interest to adopt this animal and submitting this form, I understand and agree to the following:

1. To keep this pet in accordance with local regulations.  If this animal is a dog or puppy, I will have it licensed within 30 days and then yearly.
2. To provide this animal with proper shelter, adequate food and water, and medical care to maintain his/her health and well being.
3. To establish a schedule of preventative medicine with a veterinarian.
4. To obtain immediate veterinarian care if the animal becomes sick or injured.
5. Circle Tail welcomes any questions about the care of the dog or any behavioral issues that arise during the lifetime of the dog. 
6. This animal will not be sold, traded or disposed of, and if I can no longer care for it, I can call Circle Tail to discuss rehoming options. 
7. This animal will not be used for any experimental purposes.
8. A representative from Circle Tail may visit the pet at any time upon notice.  If not satisfied with the animal’s living conditions or appearance, the animal may be reclaimed by Circle Tail.
9. Within 1 week of the original adoption date, this animal may be returned to Circle Tail for any reason and the adoption fee will be refunded. Within two weeks of the original adoption date, the animal may be returned to Circle Tail due to health or temperament reasons.  Upon providing proof of adoption, I may select a replacement animal within six months. I realize no cash refund will be given, and it will be my decision to return the animal knowing this.
10. I understand that I am able to return this animal to Circle Tail at any time in the animal's life for any reason; however, I realize that no cash refund will be given.
11. I will be personally responsible for the humane care of my adopted pet and Circle Tail, Inc. will not be held liable if this animal causes injury to a human or other animal, or damage to property after the adoption.
12. Circle Tail, Inc. reserves the right to resume ownership of the animal if the above conditions are not met.

Please acknowledge that you have read, understand, and agree to the adoption conditions by typing "YES" (all capital letters) in the following box.