Application Date December 30, 2014 Woof For Vets’ Puppy Application Form Please completely fill out the application below. Your First Name Your Last Name Your Email Your Phone - - Please provide your physical address Street Address City State Zip Code County Do you have a DD-214? YesNo Please provide some information about your living arrangements. Type of Dwelling you live in: HouseApartmentCondoOther If you live in a rental unit, are pets are allowed? YesNo Name & phone number of rental manager: With whom do you share your household? (Number of adults & number and age of children) Please tell us a little about yourself What is your primary reason for adopting a dog? Please check the answers that apply. Companion Gift Protection/Guard Dog Children want a dog Companion for current pet Emotional support Previous dog passed/ran away/no longer with you Other List breed(s) in order of preference of your ideal companion (including behaviors, coat color, age range, (etc) Which gender of dog would you prefer? MaleFemaleNo Preference Do you currently or have you previously owned any pets? YesNo If yes, what kind of pets? List any current pets or animals living in or outside your home that do not belong to you. Have you ever trained a dog? YesNo How many hours per day will your dog be left without human companionship? Explain: If there will be times when the dog is tied up or kept outside or in the garage for extended periods, explain why and for how long? If your dog is not housetrained, what methods will you use to train him/her? Please explain: Are you willing and able to pay for any future medical needs for your pet which can average $1,200/year? YesNo Under what circumstances would you not keep the dog? Check all that apply. Divorce New Baby Escaping From House/Yard Chewing Dogs Became Ill/High Vet Bills Shedding Dog Grew Too Big Kids Ignore Dog Not Obedient Enough Going to the Bathroom Inside the Home New Partner Allergic/Doesn't Like Dog Illness in Family Moving New Job Barking Digging Destructive in the House Biting Pets Didn't Get Along Redeployment Allergies Other None of the Above What is your back-up plan for the dog when you are on vacation or suffer from illness or financial difficulties? Please provide us with references. We must be able to contact any reference you give us, so make sure their information is correct or this application WILL NOT be approved List 2 references and how to contact them. Please do not list family members. Reference 1: Reference 2: List your veterinarian and how to contact them. How did you hear about us? Terms and Conditions Veteran Name: I, (name entered above), wish to adopt the dog through the Woof for Vets Corporation and agree to the following terms: I agree under circumstances that I could not keep the dog, I will provide past veterinary history of dog, including veterinarian, phone number and provided treatments. I understand the dog may or will be neutered or spayed as per arranged with Donor. I agree to ensure that this pet is never subjected to cruel or inhumane treatment; what constitutes inhumane treatment by law. I understand that no dog is to be kept chained or tied unsupervised or may not be kept outside unless someone is at home. I agree to train and provide daily exercise by leash walking or play in an enclosed area. I welcome an inspection of the property where this pet will be housed and to ensure good care and health (food, water, exercise, companionship and shelter) are being provided. May set an appointment. I agree to notify Woof for Vets of change of address, any change in the circumstances of the animal such as: loss, theft, injury or serious illness. I agree to contact Woof for Vets immediately in the event that this adoption is not successful. I understand that this pet may not be sold, given away or placed in another permanent or temporary home or organization. I understand that I will be required to return this pet should it be determined that I am in violation of all or part of this contract. I have read all terms of this contract and I understand that the Donor and Woof for Vets can make no guarantees regarding the temperament or future health of this animal. I hereby agree to release the Donor and Woof for Vets from any and all liability for damage or injury which may be caused directly or indirectly by this pet. I understand that my new pet may not be housebroken or trained and agree to provide such needed training I, the adopter, agree. You will be asked to present your Retired or Active Duty ID card. I attest that all the information I have provided in this application is true and correct. I understand that filling out an application does not guarantee adoption. I understand that if I do accept a dog that this application will become a contract. If any information contained in this application is found to be false, I understand that the adoption contract will be considered null and void, and the dog may be reclaimed. Type your full name in the box below. This counts as your electronic signature STATEMENT OF NONDISCRIMINATION: In compliance with Federal, State, and local equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, creed, religion, ancestry, sex, national origin, pregnancy, sexual orientation, age, physical handicap or disability, veteran status, marital status, or status with regard to public assistance. For assistance with this form, call: Beverly - 417-733-1081 Sue - 417-399-9047