<p> Canine Crusaders of New Jersey Dog Adoption Application</p><p>Thank you for your interest in adopting a dog rescued by CANINE CRUSADERS LLC.(Of New Jersey). We want to make certain that every animal adopted goes to a loving home where it will be well cared for. Our application asks a number of detailed questions which are necessary for our screening process..</p><p>All information will be kept confidential. If you have any questions, please call Ed at (908) 310-6513 or Ellen at (732) 715-3909 </p><p>Please allow up to a week for processing your application. Thank you!</p><p>Your full name______</p><p>Home Address______</p><p>City______State______Zip______</p><p>Home Telephone______Cell______</p><p>E-Mail______Age______</p><p>Place of Employment______Phone______</p><p>Spouse or partner’s name______</p><p>Spouse or partner’s work number______</p><p>About your home:</p><p>Type of Residence ______</p><p>Do You: own rent live with parents other:______</p><p>Name of landlord______Phone number______</p><p>How long have you lived at this residence ______</p><p>About your family: How many adults live in the house_____ Children___ Age of Children______</p><p>Are all members of the family in agreement about adopting a dog______</p><p>Is anyone in your house nervous or unsure around dogs______</p><p>Do you have many young visitors ______</p><p>Who would this dog belong to______</p><p>Plans for your new pet:</p><p>Where will you new dog live: indoor outdoor indoor most/outdoor some </p><p>Do you have a fenced yard______Dog run______Dog house______</p><p>Name number and address of your Vet ______</p><p>Will you have the dog Spay/Neutered______When______</p><p>Please list all other pets on the house </p><p>Will you provide health care on a regular basis for your new pet______</p><p>Can you provide a home for this dog for the rest of its life______</p><p>You agree to allow Canine Crusaders to call your vet and follow up as needed______</p><p>______References:</p><p>Please list 3 References (all references will be checked) name address and phone number.</p><p>1) ______</p><p>2) ______</p><p>3) ______</p><p>Pet History:</p><p>Have you ever owned a dog______how many______how many now_____</p><p>As all your family in the house lived with dogs______</p><p>Have you ever given a pet away______had one hit by a car______</p><p>Have you ever lost a pet______had one stolen______</p><p>Have you ever had a pet removed from your care______</p><p>Please list pets you have had in the past 10 years______</p><p>Preferences:</p><p>I prefer a dog that is small medium large X-large any size</p><p>Reason for adopting this dog______</p><p>Energy level preferred High medium low</p><p>How will you exercise this dog______Would you be willing to have a home visit from CCLLC and a follow up home visit in the first 6 month of adoption______</p><p>By clicking the Submit button below, I certify that:</p><p> o The information I have given is accurate o I understand that Canine Crusaders has the right to deny any application o I give permission for a representative of Canine Crusader to call the references and veterinary practices I have listed. o</p><p>Sign Here Date Print Name</p><p>Please Sign______Print Name______</p>