Adoption Application

Please copy and paste into your email program or print and complete.

Name: _______________________________________________________
Address: ______________________________________________________
City: ______________________ State: ______ Zip: __________________
Work Phone: __________________ Best time to call: _________________
Home Phone: __________________ Best time to call: _________________
E-Mail: ___________________
Occupation: ____________________ Employer: _____________________
Personal reference: ____________________ Phone: __________________
Relationship to applicant: _______________ Years acquainted: _________
Veterinary: ________________________ Phone: ____________________
List all other dogs in the household. Include breed, age and sex:
___________________________________________________________
________________________________________________________________________

Do you live in: House_____ Condo_____Apartment _____Other________
Do you: Own_____ Rent_____
How long have you lived at this current address? _______
Are you planning to move within the next year? Yes_____ No_____
Do you have a secure yard? Yes_____ No_____
Describe your yard and fence? _____________________________________
Please list how many children live in your home and ages: ______________
______________________________________________________________
Do you own any other dogs? Yes_____ No_____
Are they spayed or neutered? Yes_____ No_____
Please list names, breed and sex of each of your current pets: ____________
______________________________________________________________
Are all of your animals on heartworm preventative and flea and tick control?
Yes_____ No_____
Where would your new dog spend most of the day? Indoor _____ Outdoor _____
How many hours will your dog be alone each day? ________
Where will the dog sleep? Indoor _____ Outdoor _____
Are you willing to attend obedience classes with your dog? Yes _____ No_____

Do you agree to the following?
Spay/Neuter within 30 days? Yes _____ No_____ N/A _____
Keep current license and ID tags on the dog at all times? Yes _____ No_____
Restrain dog in an open vehicle? Yes _____ No_____
Return animal to Second Chance Animal Rescue if you can no longer keep or care for the animal?
Yes _____ No_____

Signature __________________________ Date _____/_____/______

Signature __________________________ Date_____/_____/_____

Information about the dog you would like to adopt:
Name: ______________________
Sex: Male _____ Female _____
Breed: ______________________
How did you hear about us? __________________________________________
_________________________________________________________________
Thank you,
Bonnie Lukas
President

Please e-mail completed application to: SatoHeart@yahoo.com