Please answer the following questions before deciding on your potential pet. We want to help ensure the best possible match between adopter and pet. Remember this is a lifetime commitment. You will be asked to sign a legal contract when adopting your pet and pay a donation fee (this partially reimburses any applicable vet fees, which may include spaying or neutering, heartworm testing, distemper shots, and a rabies vaccination if the dog is the appropriate age.) This adoption fee goes directly to Animal Allies and will be used only for medical care and maintenance costs for the animals we receive into our adoption system. This donation fee is not tax deductible. bold indicates required fields Name of Applicant: Name of Co-Applicant: Address: City:     State: VA MD DC AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MD ME MH MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT WA WV WI WY     Zip: Home Phone: Email: Employer (Applicant): Work Phone (Applicant): Employer (Co-Applicant): Work Phone (Co-Applicant): How many adults live in your house?      How many children?      Ages: How long have you lived at your present address? Are you planning to move in the next six months? Yes No Do you: Rent Own Single Family Townhouse Apartment Condo Govt.Housing Other: How did you hear about Animal Allies? Have you previously adopted a pet from a shelter or rescue group? Yes No Tell us about your current pets... Pet Species Age Spayed/Neutered? Inside or Outside Time Owned Yes No Yes No Yes No Have you ever owned animals that were... Killed by a moving vehicle Given away Lost or stolen Turned into a shelter or rescue group Tell us about your previous pets (within the last 5 years - no longer in your household)... Pet Species Age Spayed/Neutered? Inside or Outside Reason for Seperation Yes No Yes No Yes No Do you or your family members have any allergies to domestic animals? Yes No If allergies develop, are you willing to take steps to keep this pet? Yes No Will you let the dog outside: On leash only In fenced yard while attended Unattended Are you willing to make a lifetime commitment to this dog? Yes No Do you know the annual cost? Yes No Are you willing to provide annual vaccinations and any medical care necessary? Yes No Where will the dog be kept during the day? Where will the dog be kept at night? Who will be responsible for the care of the dog? How many hours will your dog spend alone each day? Your new dog may 2-3 months to adjust to its new home. Are you willing to provide that time? Yes No What will you do if your dog does not get along with your present pets? Who will care for the dog when you go on vacation or in your absence? Present Animal Hospital used: Phone number: Application Confirmation Dog you are applying for? By my signature below, I certify that the above statements about me and my history with companion animals are true and correct. I understand that Animal Allies reserves the right to refuse any applicant based on its adoption rules and guidelines. Any misrepresentation of fact may result in my application being rejected. My signature to this document also permits my present (or previous) Veterinarian or Animal Hospital to release requested information to an Animal Allies volunteer regarding my current or previously owned pets for the purpose of considering my application for a companion pet. If I have not received a telephone call within 2 to 30 days from the date of this application from an Animal Allies representative, I understand that my application has been declined or the dog which I have requested has been placed with another family. Signature of applicant: Signature of co-applicant: Date: