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ECPC Adoption Application
Personal Information
E-Mail:*Valid e-mail is required
First Name:*
Last Name:*
Spouse/Partner/Housemate Name:
Address Line 1:*
Address Line 2:
City:*
State:*
Zip Code:*
County
Is your yard fenced?*
What type & How high is your fence?*
How long have you lived at your current address?*
If less than three years, please list previous address?
Marital Status:*
Gender:*
Date of Birth:
Phone:*
How many children live in the home:*
Ages:
How many adults live in the home :*
Do all adults work outside the home:*
Yes No 
Do you:*
Own your property
Rent your property
Live with your parents
If renting, does lease allow for pets?*
Yes No N/A 
If renting, please provide landlord`s name and telephone number:*
What type of home do you live in?*
Describe your home:*
Does anyone in the Family have a known allergy to Dogs?*
yes
no
Is everyone in agreement with the decision to adopt a dog?*
Adoption Related Information
Which pet are you interested in?*
Desired Age?*
Desired Size*
Desired Breed?*
Willing to Adopt:*
Reason for adopting a cat or dog:*you may choose more than one
Do you have time to provide adequate love and attention?*
yes No 
Do you have a fenced in yard?*
Yes No 
Do you agree to keep this dog as and indoor dog*
Yes
No
Do you currently own a pet?*
Yes No 
Please list all companion animals you currently have:include type of pet & age
Is your Pet Spayed/Neutered?*
Yes
No
N/A
Where does this pet spend most of it`s time?*
Are these pets up to date on Vaccines?*
yes No N/A 
Are these pets on Monthly Preventatives(Heartgard, Flea/Tick)?*
yes
No
N/A
How many hours a day will your new pet be without human companionship?*
Pets usually require minimum cost of $500 per year for veterinary care, food, and other related expenses.
Are you willing and able to afford these costs?*
Yes No 
Do you agree to provide regular Health Care by a Licensed Verterinarian?*
Yes
No
Do you agree to keep this Dog on Monthly Preventatives?*
Yes
No
Have you ever had to give up or find another home for a pet in the past?*
Yes No 
If yes, please explain?
would you return your Adopted pet? why?*
Veterinarians name:
Veterinarians Phone Number:
Name Pet(s) is Listed Under?
If you never had a pet, please supply 3 Personal references:*
Are you willing to let a representative of ECPC visit your home by Appointment?*
Yes
No
By Submitting this Application you agree to the Following:
all the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccines, Give Monthly Preventatives under the supervision of a Licensed Veterinarian.
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