My name is Kahlua!

READY DATE -now
Age- 7 months
FEE $ 250.00
INCLUDES spay/neuter wellness exam, vaccines to date, dewormed and flea treated. ******READ HERE BEFORE YOU CALL *******
********PLEASE COPY & PASTE THIS ADOPT FORM ,COMPLETE AND SUBMIT TO*** ngas@cox.net and Then a meet and greet with pet can be scheduled.
**** ADOPT FORM****
If you are renting/leasing You will need to provide permission from the property manager allowing this breed or pet and that you have paid pet deposit to your manager if required in your lease.
Are you moving/ relocating ?____________ When?_______
Managers contact information __________________________________________________________
I certify that I am 21 years of age .
Are you willing to have a visit to your home before or after this adoption? _____
Name /breed of companion you are interested in adopting?____________________
Do you have hands on experience with the breed you want to adopt ?_____
Applicant Name: ___________________________________________Age___
Co-Applicant Name:________________________________________Age____
Address____________________________________City________State____
Zipcode______________ Phone: __________________________________
Can we text you?_____ Email:__________________________________
Employment _________________________ Phone________________ Supervisor________________ How long at this employment ?______
Co-Applicant Employment ____________________Phone__________________
List ages of all the people who will be involved with this pet /living in home, visit on a daily basis or weekends . Any day care children or family care members.
Adults/seniors/roomates ages ________________All Children ages__________________________
Current companions: Dogs, #____ Cats, #____ Is Cat/Cats Declawed_______
Are they Spayed / Neutered?_____ IF NO, Why?________________________________________
Pets Ages_______________________Breeds____________________Other pets______________
Are your pets Indoor__ Outdoor__ Both__ Pet door___ Garage____ kennel___ Other_______
Your current veterinarians phone number ______________________________________________
Do you have transportation to get this pet to a veterinarian? Yes__ No___
Companion History: When did YOU last own/care for a dog or cat? _______
Where is this pet now? __________________________________________________
Were they spayed/neutered ? ____ Who was your veterinarian Veterinarian__________________Phone____________________________
What brand of pet food will you feed this pet as a regular diet_________________
What type of flea products will you use on this pet?_________________Heart worm meds?_______
How many hours each day will this pet be alone______ Where will he/she be kept?______________________________ Day care___ Take to work___ Work from home___
Explain crate schedule and reasons for using a crate______________________________________________________________________________
Crate Hours: Daytime _____Night Time Hours_____ How many days a week____
What type of fence do you have?_____________________No fenced yard______
When/where will you take dog to play and get exercise ?________________________________
Taking dog for walks to go potty____ How many times a day___Will be potty pad training________
Have you carefully considered the size of this pet once he/she is fully grown?__________
If you have stairs/steps __ How many and where__________________________________
Are you prepared for any issues like Jumping___ Chewing___Digging___Barking_____Potty accidents
Until pet gets houstrained or settled into home?____ Please think about these things no pet is perfect.
Pet Planning :Going Away on Vacation, Work trips, Emergency situations. etc
Will you take this pet with you ____Have a Petsitter/Inhome caretaker ___Board __Take to family friend, neighbor Please List their name & phone number _________________________________
Are you In a House____ Apartment___ Condo___ Mobile Home__ Military Housing__
Buying ___Renting __ Month to Month___ Living with someone ___Hotel__
What reasons would cause you to give away a pet?______________________________________
If you are unable to care for this pet where will pet go? __________________________________
REFERENCES: Please list 2 references, Vet, Pet sitter, Groomer, Neighbor, Friend
1. Name_________________________________ Phone (____)_________________
2. Name_________________________________ Phone (____)__________________
By signing below I attest that I have Never been convicted of animal abuse, Animal cruelty,
Neglect or abandonment in the state of Virginia Or any other state or country.
Any untruthful answers or not meeting the requirements for this adoption can result in the forfeiture of the companion adopted by me?
Do you and all persons that will be involved with the care of this pet agree that yearly vet care, time, finances, love and long term commitment will be given to this pet ?_________
I have read this form and understand that applying does not ensure approval. Visiting a companion does not ensure Adoption.
Applicant Name Print_______________________________Date_____
Applicant Signature________________________________Date_____
Co-Applicant Name print____________________________________Date_______
Co-applicant Signature______________________________________Date_______
return to ngas@cox.net