<p>KARIN 4 KRITTERS 411 Hillsboro St. Return application to address listed or fax to :731-235-2136 GREENFIELD, TENNESSEE 38230</p><p>Name of Dog applying for: ______Date you can come in: ______DOG ADOPTION APPLICATION (Please Print Clearly & Answer all Questions.) Karin 4 Kritters has the right to refuse adoption to anyone. Applicant's name______Driver’s License #:______Local Address______Apt#______City______State______Zip______Home Phone ______Work Phone ______Email ______DESCRIPTION OF RESIDENCE: Do you Rent?______Own?______House Property owner's name:______Phone______Apartment How long have you lived here?______Mobile-Home ___Duplex #Adults in house______#Children______Children's Ages______WHAT PETS DO YOU CURRENTLY HAVE IN YOUR HOUSEHOLD?</p><p>KIND SPAY/NEUTER KEPT WHERE? TIME OWNED ___ AGE </p><p>Dog__Cat__ | Yes___No___ | In____Out___ |______|______| Dog__Cat__ | Yes___No___ | In____Out___ |______|______| Dog__Cat__ | Yes___No___ | In____Out___ |______|______| Other_____ | Yes___No___ | In____Out___ |______|______|</p><p>LIST PREVIOUS PETS WHAT HAPPENED KIND SPAY/NEUTER KEPT WHERE? TIME OWNED TO PET______</p><p>Dog__Cat__ | Yes___No___ | In____Out___ |______|______| Dog__Cat__ | Yes___No___ | In____Out___ |______|______| ______</p><p> Are you at least 18 years old?______Yes______No  What is the name of your veterinarian?______ Veterinarian's address______ How long have you used this Vet? ______ Who will be responsible for the daily care/feeding of this dog? ______ Who will financially support this dog?______ Reason for wanting this dog?______ Where will you keep this dog?______ Where will you keep this dog when you TRAVEL?______ Do all members of this household WANT this dog?______</p><p>Continue to Page 2 Revised November 2004 by H. Griffith Page 2</p><p> If you have young children, they need to be educated on how to interact with the dog in order to prevent dog bites, are you able/willing to do that? ___Yes ___No  How long will you give this dog to adjust to its new home?______ How many hours will your dog spend alone?______ If you must give up this dog, must agree to contact Karin 4 Kritters and have them approve new adoptee or that will take back custody of dog______ Would you object to a follow-up home visit by the Karin 4 Kritters?Yes No Best day/time: ______ What amount of time will the dog be inside?______outside?______ If adopting an outside dog, do you have a doghouse? ______Yes_____No  If adopting an outside dog, do you have a fenced yard?_____Yes_____No  If adopting an outside dog, do you have a shaded area?_____Yes_____No  Do you realize that an outside dog may entertain itself by digging, chewing home items and/or escaping and wandering? ___Yes ___No</p><p> What will you do if your dog shows destructive behavior? (Digging, chewing, jumping, tearing up plants/furniture or running off) ______ Do you realize that you will probably have to housetrain your new puppy/dog? ____Yes____No  Would you like information on how to housetrain a new puppy or dog? ____Yes____No  If adopting an adult dog, how many times per day will you exercise it? 1 2 3  What form of exercise will you provide for your dog? ______</p><p> What form of training will you provide your dog? __Obedience class __Follow training books __Professional training __Home training</p><p> Will you have your dog SPAYED OR NEUTERED within the recommended time frame? (A surgical operation to prevent parenthood for animals) If not already neutered and spayed ____Yes ____No  Where/who will perform the surgery? ______ What type of balanced nutrition do you intend to provide for your dog? Dog Food Brand:______Dry or Wet  Will you have this dog vaccinated annually, by a veterinarian, against infectious disease?______Veterinarian:______ Are you familiar with heartworm disease?______Yes______No  Will you maintain your dog on heartworm preventative? _____Yes_____No  Do you realize that dogs often live longer than 10 years and are you willing to assume responsibility for that long?______Yes_____No</p><p> How will you keep the dog confined to your property? (Check all that apply) ___House____Kennel____Fence____Chain___Patio_____Garage___Leash____Other</p><p> Where did you hear about the Karin 4 Kritters Animal Shelter? ___Friend____Relative___Radio___Billboard___Petfinder ___Internet ___Other</p><p> Have you applied to adopt from this shelter before today? ___Yes ___No Date:______Pet Adopted? Yes No If yes, where is this animal now? ______</p><p>Please supply 2 references : Name and contact number</p><p>Page 2 Revised November 2004 by H. Griffith I certify the above is true and that false information may result in nullifying this adoption. Karin 4 Kritters has the right to refuse adoption to anyone. I understand that no animal can be held for me.</p><p>Signature______Date______</p><p>Additional notes or comments:______</p><p>Continue to Page 2 Revision November 2004 H. Griffith</p>