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PO Box 821
Burgaw, NC 28425
910-259-7911
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EIN: 11-3814420
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Sponsored by Monty's Home

   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? *  Yes
 No
If yes, what type of fence?   
If no, how will the dog be exercised?   
Where will the dog sleep? *   
Children? *  Yes
 No
If yes, ages   
Are you or anyone in the household allergic to animals?  Yes
 No
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 (non-related):
Name *   
Phone *   
Name *   
Phone *   
Name *   
Phone *   
Have you ever attended obedience classes with a pet?  Yes
 No
Where?   
Are you a member of any dog-related clubs?  Yes
 No
Names   
What happened to previous pets? *   
Have any been surrendered or given away? *  Yes
 No
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 Small
 Small
 Medium
 Large
 Extra Large
Hair Length:  Long
 Short
Gender  Male
 Female
 Does not Matter
Age preference   
Energy level of your new pet would best be described as:   
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?  Yes
 No
To you, what is the ONE most important thing about your pet?   
The least important?   
Additional comments regarding preferences or concerns with your adoption:   
 
 

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