NE/CO K9's
Application for Adoption

Please remember to include your email address or your application will be rejected.

Date: Name: (First, Last): Email Address: Street: City/State/Zip: Name of dog(S) Interested in (if known): Home Tel#: Work Tel#: Occupation:   Please list the name, age, and relationship of all persons residing in your household, beginning with yourself. If more spaces are needed please add to final comments. Name Relationship Age Is everyone in the residence and family agreeable to your adopting a rescue dog? Yes No Who will be primarily responsible for the care of your new pet? If you have children and/or frequent visitors to your home, please answer the following questions: Do you currently have very young children? Yes No Are you frequently visited by very young children? Yes No Are you aware that small breeds are not the best choice for families with very young children? Yes No Are you aware that large breeds can be too aggressive for families with very young children? Yes No Have your children had exposure to owning and caring for family pets such as dogs or cats before? Yes No to desired breed in particular? Yes NO If "no" , will you teach your children to love and care for your new pet in a humane manner? Yes No In the event your new dog becomes aggitated by or frightened of loud children or visitors to your home, do you have the ability to separate your pet from children or visitors to avoid problems? (i.e. gated or separate rooms, fenced outdoor areas, etc.) Yes No If "yes", how? Does anyone in the residence have animal allergies? Yes No Asthma? Yes No YOUR HOME Type of residence? house/condo/townhome mobile home apartment other Do you own or rent? Own Rent If renting, be advised you must provide written documentation to NE/CO K9's from your landlord confirming you are authorized to house and maintain pets on the property (i.e. letter from landlord, pet addendum, or proof of pet deposits). Landlord's Name: Landlord's Address: Landlord's Tel #:   Are there stairs in your residence? YES No *If "yes", are you aware that some small breeds are prone to back strain and injuries and should not be allowed to climb stairs? Yes No Do you have a yard? Yes No Approximate size? If "yes", is it completely fenced? Yes No If yes, type/height? If no, are you willing to fence it, install a dog run, or leash walk at all times? Yes No Do you feel it acceptable to let your dog roam freely? Yes No Where will the dog be kept during the day? Where will the dog sleep? Where and how will the dog be exercised? How many hours a day will the dog be at home alone? Where will the dog stay when you're on vacation/business, away from home? Have you ever house trained a dog before? Yes No *If "yes", how? ADOPTION PREFERENCES Please indicate your desired preferences to assist us in our search for a compatible pet companion. Do you have any breed preference? SIZE: Toy Small Medium Large GENDER: MaleFemale COAT: Smooth Hair   Long Hair  Wire Hair AGE: Under 1 year (rarely available)  1-3 years  4-7 years  8 yrs and above   Are you willing to adopt a dog that is: 8 years of age or older? Yes  No   Not reliable with children? Yes  No   Physically handicapped? Yes  No   Requires ongoing medication other than heartworm preventative? Yes  No   Requires continued house training? Yes  No   Has been abused? Yes  No   On occasion we receive pairs of dogs who may or may not be siblings but who nonetheless have bonded and need to remain together . Would you consider adopting such a pair, if available? Yes  No   Will you be willing to take your dog for obedience training if needed? Yes  No   As any other animal dogs vary greatly in temperament, personality, and activity level. What characteristics, if any, would you find undesirable in a pet? PET HISTORY: Do you currently own any pets? Yes  No   *If yes, please list species, breed, sex, whether the pet is neutered or spayed, if the pet is kept primarily inside or outside and how long you have owned this pet. See example below. Species Pet Name/Breed Sex Spay/Neutered? Age Kept In/Out? Owned? German Shepard Dog Brandy Female Spayed 8 months Inside 5 months Are your pets current on Heartworm preventative? Yes  No  N/A   *What kind? How often are they tested for Heartworms? Are your pets current on vaccinations/shots? Yes  No  N/A   How would your characterize your pets? (dominant, submissive, playful, etc.): Will your pets accept a new dog? Yes  Not Sure   ARE YOU WILLING TO: Take the dog to a veterinarian at least once a year for a physical exam, shots, and heartworm check? Yes Take the dog to a veterinarian when ill? Yes Welcome the dog into your family as a permanent member? Yes Return the dog ONLY to NE/CO K9's if you decide that he/she cannot be a member of you family? Yes Maintain heartworm preventative medications throughout the dog's life? Yes VETERINARIAN INFORMATION (REQUIRED) Name: Address: City/State/Zip: Tel # :   If you have previously owned pets, what happened to those no longer living with you? Are you currently breeding your dogs/cats to have puppies/ kittens? Yes  No   Have you ever bred dogs or cats? Yes  No   REFERENCES: Please provide two personal references (three if there is no veterinarian reference listed above). Please list the person's name, address, telephone number and or email, and their relationship to you (sister, brother, friend, employer, co-worker, neighbor, etc.). Name, Address & Phone/email Time known Relationship to You EX:Brandy Sheppard 452 Any St, Town Fl ,jd@aol.com 3 Years Family Friend CERTIFICATION By my signature below, I certify that I am at least 21 years of age and will assume full responsibility for the care and well-being of any dog that I adopt through NE/CO K9's. I further agree to be contractually bound upon adoption to 1) take my adopted dog to a veterinarian at least once a year for a physical exam, shots, and heartworm check, 2) take my adopted dog to a veterinarian in a timely manner when ill, 3) to maintain heartworm preventive medications and flea/tick treatments throughout the dog's life, and 4) to return my adopted dog to NE/CO K9's and only to NE/CO K9's should circumstances change and I can no longer care for my adopted dog in a humane manner. I understand that this is only an application and NE/CO K9's hold the final desicion as to the status of this adoption. The information provided in this application (in its entirety) is true to the best of my knowledge as of the date on this application. I agree that submission of this form will constitute a legally signed document SIGNATURE: DATE:   (NOTE: If filing electronically, your typed name followed by your email mail address entered above will constitute your “signature” by electronic submission.)