In order to be considered as an adopter you must:
· Be 21 years of age or older.
· Have identification showing your present address.
· Have the knowledge and consent of your landlord.
· Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet.

Completion of this application does not guarantee adoption of a Stray Atlanta dog. Once you have completed the Application, please fax the application to: 404-745-0067.

Application, Adoption Fee of $175.00, and Homecheck required.

Name of Applicant: _______________________________Date __________________

Name of Spouse/Partner: _________________________________________________

Street Address: _________________________________________________________

City: ___________________________State: __________________ Zip: ____________

Phone #: (h) __________________ (w) ______________________ (cell) _________

Primary E-mail: __________________________________________________________

Secondary E-mail: _______________________________________________________

Employeer: _____________________________________Years at Current Job:_____

Occupation: ____________________________________________________________

1. Which dog are you interested in? _______________________________________

2. Would this be your first dog? ___________________________________________

3. What kind of pets have you had in the past? ______________________________

4. Which of these do you still have? (Include age, sex and breed) _______________

_______________________________________________________________________

5. Have they been spayed or neutered? (circle one)   Yes   No   Don't know

6. Are they current on vaccinations? (circle one)   Yes   No   Don't know

7. What happened to the ones you no longer have?__________________________

________________________________________________________________________

8. If you have pets will he/she/they adjust to a new dog in the house? _________

9. How long will you give your "new" pet to adjust to the new home? _________

10. How do you plan on introducing your new pet to your current pets? ______

_______________________________________________________________________

11. Was your last dog obedience trained? (circle one)   Yes   No   Doesn't Apply

12. Why do you want this dog? (circle all that apply)   Companion   Companion for other pet   

House pet      Watch dog      Guard dog      Hunting       Personal protection

Other: ____________________________________________________________________

13. How many adults are there in your family? _________________________________

How many children? ________________Children's ages: __________________________

14. Does any member of your household have an allergy to dogs? _________________

15. Is someone home during the day? ___________ Who? __________________________

16. How many hours each day will the dog be without human companionship? _______

Explain: ______________________________________________________________________

17. Which do you live in? (circle one)    House   Apartment    Condo    Mobile Home

Other If other, explain_________________________________________________________

18. Do you own or rent your home? (circle one)    Own    Rent

If you rent, may we contact the owner? (circle one) Yes    No

Owner's name & phone number: _____________________________________________

19. Do you have a completely fenced yard? (circle one) Yes    No

If yes, what kind of fence? ____________ Height ______________
Is there a gate? (circle one) Yes    No

20. Do you have a dog door? (circle one) Yes    No

If no, would you put one in? (circle one) Yes    No

21. If your new dog/puppy is not housetrained, what method will you use to train it?

_________________________________________________________________________

22. For which of the following reasons would you give up your dog? (circle all that apply)

moving    new baby    not getting along with other pets    divorce   

getting out of fence    behavioral problems   medical problems

shedding    children lost interest    increased work hours    allergies    not housetrained

aggressive    gets too big    not getting along with children    none    other

23. Will you keep the dog up-to-date on vaccinations? (circle one) Yes    No

24. Who is your veterinarian? _________________________________________________

Please give your veterinarian's contact information:
Name: _______________________________

Phone: _____________________________________________________________________

25. What brand of food will you feed you new dog? ______________________________

26 Are you able and willing to exercise the dog on a regular basis? (circle one) Yes    No

Method: _____________________________________________________________________

27. Where will this dog be kept during the day? __________________________________

28. Where will your new pet sleep at night?    In crate   in basement    in kitchen

doghouse in fenced are     in one room of house    doghouse in dog run   free run of house  

in your bed      free run outside     in child's room     on floor in your bedroom     

doghouse with tie-out     in the garage     other

29. If you drive a pickup truck, would you allow the dog to ride in the bed?
(circle one) Yes    No

30. If you go away for a few days, or on a vacation, who will take care of the dog?

_________________________________________________________________________

31. If you must move, will you take the dog with you? (circle one) Yes    No

32. Have you ever applied to adopt a dog from another rescue group?
(circle one) Yes    No

33. Are you willing to have a representative of Stray Atlanta come to see where
the dog will be living? (circle one) Yes    No

34. Are you willing to take the responsibility for this dog for the next ten to
fifteen years? (circle one) Yes    No

35. What provisions will you make for the dog should you become unable
to care for it?

____________________________________________________________________

36. Suppose your pet develops a medical problem that becomes expensive,
(some treatments can cost thousands of dollars).

What would you do? __________________________________________________

37. How did you hear about Stray Atlanta?_____________________________________

38. General comments by applicant_________________________________________

_________________________________________________________________________

39. Please list the name & phone number of three personal references:

1) _________________________________________________________________________

2) _________________________________________________________________________

3) _________________________________________________________________________

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of a rescue dog and possible removal of said pet from my home.

Signature: ____________________________________________________________

Date: ___________________

Signature: ____________________________________________________________

Date: ___________________