PETS IN NEED In Southern Maryland

Animal Adoption Application

What pet(s) are you interested in ?
Name: _________________________ Breed: _____________________________
Male or Female? If you are not chosen for this animal, will you consider another in need?
Yes or No
Completion of this application does not guarantee adoption of a Pets In Need In Southern
Maryland (PIN) animal.

First Name: _________________________ Last Name: ______________________

Occupation: __________________________________________________________
Names (and ages) of children, if any:________________________________________
Street Address: ______________________________________________________
City: __________________________ State: _________ Zip Code: ______________
Email: _______________________ Contact Phone Numbers: ___________________
List all pets you have owned the past five years
NAME BREED SEX Spayed/ Age How long have Indoors/ Where is
Cat/Dog Neutered you had it? Outdoors the pet
now?

Vet Reference, Name and Address: _________________________________________

1.) Do you live in a House ____ Apartment ___ Condo ___ Town House ____ Other _____
2.) How long have you lived at this address: __________ Do you Own _____ Rent _____
(If you rent we will need a Landlord Approval Letter stating it is okay to have a pet)
3.) Landlord's name and phone number: _______________________________________
4.) How much of the time will dog be outdoors? ___________________ Indoors?______
5.) About what percent of the time will the dog be left alone? _____________________
6.) Where will the dog sleep at night? _______________________________________
7.) Do you have a fenced yard? _____________ How high is the fence/type? _________
8.) Who will be responsible for taking care of the pet? ___________________________
9.) What would happen to the dog if you move? _______________________________
10.) Does anyone in your household have allergies: ___________ What kind? _________
11.) Why do you want a dog? House Pet ___ Companion ___ Protection___ Protection for
business?___ Hunting? ___ Watchdog?___ Gift?___ Other?___
12.) How would you train this dog? Obedience school ___ Spray bottle with water___
Clicker/hand signals ___ Hit with newspaper ___ Firm verbal commands ___ Spanking ___
Other ___
13.) Are you able to make long term commitment to care for your pet for it's entire life
span, which could be as much as 10 to 20 years? Yes ___ No ___
14.) If behavioral problems arise what steps will you take to work on it?
____________________________________________________________________
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of
the above information will be grounds of rejection of this application and possible removal
of adopted dog from my home. I consent to Pets In Need In Southern Maryland
representatives discussing information on this application with any persons named of the
application. Pets In Need In Southern Maryland reserves the right to refuse an application
for any reason. All completed applications become property of Pets In Need In Southern
Maryland.

I give Pets In Need In Southern Maryland to fully investigate the information provided as
well as contact veterinarians and related officials. If the application passes this review, I
agree to a home visit on a mutually agreed date by a Pets In Need representative before an
adoption decision is made.

Signature of Applicant: _____________________________ Date: _____________