Dog Application Form

Pet Name *

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Section I — Adopter Information

General Information

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1. Where do you live:

2. Do you:

3. Have you ever adopted a pet from Kiya Koda?

4. Have you ever been refused adoption of a pet from Kiya Koda or any other shelter?

If yes, why?

5. Have you ever been involved with an animal control department?

If yes, what were the circumstances?

Section II — Household Details

1. How many adults live in your household?

How many children?

2. What will be this pet's role in the family? Please check all that apply.

3. Who will be responsible for Training this pet?

4. Are there any pets in the home now?

If so, please fill out this chart: Type/Breed Where kept Age Spayed/Neutered Vaccinated Still own If no, why?

Type/Breed Age Spay/Neutered? Vaccinated? Still own? If no why? Action



5. Who will be this pet's Veterinarian?

6. If you move in the future, what will you do with this pet and your other pets?

Section III — Role in the Family

1. Do you know that in the first year, regular preventative care may cost $150+ for a dog?

2. Did you know that in the first year, pet food and pet supplies may cost $100+?

3. About how many hours per day will this pet be alone in the home without human companionship?

How many days per week?

4. Where will this pet be kept during the day?

At night?

5. Do you have a fenced yard?

If yes, please describe the fence (height/materials):

If no, do you plan to build a fence in the future?

6. A shelter is an insulated structure that has bedding inside. Shelter keeps pets warm in the winter, cool in the summer and gives them room to stand up, stretch out, and lie down comfortably. Will your new pet have shelter?

7. Do you plan to use chain, rope or cables as the only means of keeping this pet confined?

8. Do you understand that state law might require vaccinating, leashing and licensing dogs?

9. Do you plan to housetrain this pet?

If yes, how?

10. It may take two weeks or more for this new pet to adjust to your home (depending on the household). Are you willing to give ample time for adjustment?