PO Box 821
Burgaw, NC 28425
910-259-7911
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EIN: 11-3814420
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ADOPTION APPLICATION
PRINT APPLICATION
*Required Fields Must Be Completed
PART 1 - PERSONAL DATA
Applicant's Name *
Address *
City, State, and Zip *
Telephone Number *
Alternate Telephone
Work Phone
Email *
Do you *
own
rent
Landlord Name
Landlord Phone
Fenced yard? *
No
Yes
If yes, what type of fence?
If no, how will the dog be exercised?
Where will the dog sleep? *
Children? *
No
Yes
If yes, ages
Are you or anyone in the household allergic to animals?
No
Yes
Other pets *
Place of Employment
How long at present job?
If less than a year, please provide previous employer
Work Hours
Co applicant name and work hours
Veterinarian's name (for current or previous pets) *
Phone number
Kennels or pet sitters used in the past
Personal References:
Name *
Phone *
Name
Phone
Name
Phone
Have you ever attended obedience classes with a pet?
No
Yes
Where?
Are you a member of any dog-related clubs?
No
Yes
Names
What happened to previous pets? *
Have any been surrendered or given away? *
No
Yes
Circumstances?
PART 2 - DOG PREFERENCES
Dogs from Monty's Home Pawsitive Partners Prison Program are rescued from local animal shelters.
Although exact breed is unknown we do want to match the type of dog you prefer to one in our system by answering the following questions.
What breed of dog would you purchase if you were to buy a dog? 1.
2.
3.
If no specific breed: Size / Weight
Extra Large
Extra Small
Large
Medium
Small
Hair Length:
Long
Short
Gender
Does not Matter
Female
Male
Age preference
Energy level of your new pet would best be described as:
Hiker/Rock Climber/Cross Country Skier
Lay on the couch all day lazy relative
Marathon Runner/Pro Football Player/ Olympic Athlete
Retired but active senior citizen
White collar 9-5 office worker
What activities do you want to share with your new dog?
What training goals do you have for your new pet?
Are you interested in therapy dog training and certification?
No
Yes
To you, what is the ONE most important thing about your pet?
The least important?
Additional comments regarding preferences or concerns with your adoption:
Burgaw, NC 28425
910-259-7911