Name of dog you are interested in*Date*Adopter InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home phone*Cell phoneEmail* REFERENCES(Must be someone other than an immediate family member)Personal Reference Name*Phone*How you know this person*Your Employer*Phone*1. Why are you considering adding a pet to your life?* Companion for Children Companion for Adults Companion for other pets Companion for Family Working dog Protection Other Why are you considering adding a pet to your life?*2. How many people live in your home?*3. If you have children, what are their ages?*4. Does everyone in the house want a pet?*5. Do any family members have allergies or asthma?*6. Will this animal be given as a gift?*7. Have you ever owned pets before?*8. If yes, how long did you have your pets?9. If pet(s) is/are no longer with you, what were the circumstances of the passing or absence?10. What other pets live with you?* 11. Do you live in a:* House Condo Apartment Mobile Home Military Housing Other Other Housing12. Do you own or rent your home?* Own Rent If renting, do you have your landlord’s permission to have a pet? Yes No If renting, may we contact your landlord? Yes No Landlord’s namePhone13. Do you have a yard?* Yes No Is yard fenced? Yes No Height of yard fence14. Do you have a pool?* Yes No Is pool fenced? Yes No Height of pool fence15. Where will your new pet be when you are not at home?*16. If your pet will be outdoors, will he/she be chained or tied up? Yes No 17. How many hours per day will your pet be left alone?*18. May we visit your home for a basic safety and security check?* Yes No 19. Do you have the time and will you make the commitment to train your new pet should behavior concerns arise?* Yes No 20. Pets are an addition to the family, and as such will require investment of your time and money for medical care, grooming, appropriate food, water, proper shelter, clean environment, exercise, attention, affection, and protection from harm. Are you willing and able to provide the appropriate resources that your new pet requires?* Yes No 21. VeterinarianPhoneVet’s clinic or hospital name:22. This pet is not to be passed into other hands without approval of SPOT. Do you agree that if for any reason you could not keep this pet you will contact SPOT?* Yes No Please contact SPOT with least one week notice for return to allow us time to find a foster home. Call 760-593-7768* I CERTIFY THAT THE ABOVE IS TRUE, AND THAT ANY FALSE INFORMATION MAY RESULT IN NULYFING MY APPLICATION. I AGREE TO ACCEPT THE DECISION OF SPOT REGARDING THE SUITABILITY OF ADOPTING A PET. I UNDERSTAND THAT SAID DECISION IS FINAL AND IF NOT APPROVED, NO EXPLANATION OR JUSTIFICATION IS NECESSARY. I ALSO UNDERSTAND THAT FILLING OUT THIS APPLICATION DOES NOT GUARANTEE THAT I WILL BE SELECTED TO ADOPT THIS ANIMAL. DIGITAL SIGNATURE*Please type your first and last name above.If you would like to have a copy of the form please print this document before submittingCommentsThis field is for validation purposes and should be left unchanged.