Dog Adoption Form

CONTACT INFORMATION :

Full Name*

DOB *

Spouse Name*

DOB *

Occupations

Address (Physical)*

How Long Have You Lived At This Address*

Mailing Address*

Daytime Phone*

Evening Phone *

Best Time To Call*

Email address *

HOW MANY ADULTS ARE THERE IN THE HOUSEHOLD (THEIR RELATIONSHIP TO YOU)?

HOW MANY CHILDREN (AGES)?

WHAT TYPE OF HOME DO YOU LIVE IN SINGLE FAMILY, TOWN HOME, APARTMENT, ETC. ?

PLEASE DESCRIBE YOUR HOUSEHOLD

if you rent, please give the rules governing pets and landlord's name and number :

by providing this information, you are allowing us to contact your landlord- please inform them of this call so they will speak with us!

DOES ANYONE IN THE FAMILY HAVE A KNOWN ALLERGY TO DOGS?

IS EVERYONE IN AGREEMENT WITH THE DECISION TO ADOPT A DOG ?

DO YOU HAVE TIME TO PROVIDE ADEQUATE LOVE AND ATTENTION ?

ARE YOU WILLING TO DO TRAINING WITH YOUR ADOPTED DOG ?

OTHER PETS :

WHAT OTHER PETS DO YOU HAVE (SPECIFY TYPE AND NUMBER)?

ARE THESE PETS UP TO DATE ON VACCINATIONS ?

ARE THESE PETS SPAYED/NEUTURED? IF NOT, WHY ?

HAVE YOU EVER SURRENDERED A PET? IF SO, WHY ?

HAVE YOU EVER HAD A PET EUTHANIZED? IF SO, WHY ?

HAVE YOU EVER LOST A PET TO AN ACCIDENT ?

HOW DO YOU DISCIPLINE YOUR PETS AND WHY ?

VETERINARIAN :

DO YOU HAVE A REGULAR VETERINARIAN?

VETERINARIAN'S NAME ?

CLINIC NAME ?

CLINIC ADDRESS ?

CLINIC PHONE ?

(by providing this information, you are allowing us to call your vet please call your vet and ask them to authorize the release of information)

PERSONAL REFERENCE :

NAME

ADDRESS ?

PHONE

RELATIONSHIP (relative, neighborhood, friend, etc.)

YEARS ACQUINTED

ABOUT THE DOG YOU WISH TO ADOPT :

WHAT IS YOUR IDEA OF AN IDEAL DOG? AND WHY?

DESIRED AGE

DESIRED SIZE

DESIRED BREED

BREED YOU WOULD NOT WANT TO ADOPT

DESIRED SEX

WILLING TO ADOPT

WHERE WILL THE DOG SPEND THE DAY? (describe)

WHERE WILL THE DOG SPEND THE NIGHT? (describe)

NUMBER OF HOURS (on average) DOG WILL SPEND ALONE ?

WHO WILL HAVE PRIMARY RESPONSIBILITY FOR THE DOG'S DAILY CARE ?

WHO WILL HAVE FINANCIAL RESPONSIBILITY FOR THIS DOG ?

Do you agree to provide regular health care by a Licenced Veterinarian ?

Do you agree to keep the dog as an indoor dog ?

When the dog goes out, how do you plan to supervise it ? Fence yard?

Do you agree to contact PET RECESS INC. if you can no longer keep this dog ?

Would you be interested in fostering ?

ALL OF THE INFORMATION I HAVE GIVEN IS TRUE AND COMPLETE. THIS DOG WILL RESIDE IN MY HOUSE AS A FAMILY PET. I WILL PROVIDE IT WITH QUALITY DOG FOOD, PLENTY OF FRESH WATER, INDOOR SHELTER, AFFECTION, ANNUAL PHYSICAL EXAMINATION AND VACCINATIONS UNDER THE SUPERVISION OF A LICENSED VETERINARIAN

PRINTED NAME

SIGNATURE

DATE

Address

36 Main Street, Lakeville, MA 02347

Located On Route 105 Just Off Exit 12 On Interstate 495 Next to Walgreens & the Middleboro/Lakeville Station for the Commuter Rail Directly Into Boston

Hours of Operation

Monday – Friday, 6:30 a.m. – 7:00 p.m.
(Closed 12:00 p.m. to 2:00 p.m. for Nap Time)

Please note that no drop-offs or pickups are allowed between 12-2pm for nap time. Shhhhhhhhh!

Saturday, 8:00 a.m. – 5:00 p.m. (Except for Boarding Dogs)
Sunday Boarding Pickup & Drop Off Only by Appointment,
8:00 a.m. – 10:00 a.m. & 5:00 p.m. – 7:00 p.m.

Email Us 24 Hours a Day, 7 Days a Week

Service Area

Lakeville, Middleboro, Raynham, Taunton, Bridgewater, E and W Bridgewater, Halifax, Plympton, Plymouth, Easton, Kingston, Mansfield, East Taunton, Freetown, Berkley, Carver, Assonet, Acushnet, Rochester, Mattapoisett, Marion, Fairhaven, Wareham, Onset, MA, & the Buzzards Bay Area