Amsterdog Adoption/Foster Application

Amsterdog Adoption/Foster Application copy

First Name (*)	please enter your first name
Middle Initial	Invalid Input
Last Name (*)	please enter your last name
Date of Birth (*)	please enter your date of birth
Co-Applicant First Name	Invalid Input
Co-Applicant Middle Initial	Invalid Input
Co-Applicant Last Name	Invalid Input
Co-Applicant Date of Birth	Invalid Input
Street Address (*)	please enter your street address
Street Address Continued	Invalid Input
City (*)	please enter your city
State (*)	please choose a state
Zip Code (*)	please enter your zip code

How Long Have You Lived at Your Current Address? (*)	how long have you lived at your current address?
Phone Number (*)	Please enter your phone number
Cell Phone	Please enter a cell phone number
Email Address	please enter your email address
Best Time to Call	Please tell us when the best time to call you is
Occupation	Please tell us your occupation
Business Address	Invalid Input
Business Address Continued	Invalid Input
City	Invalid Input
State	Invalid Input
Zip Code	Invalid Input
Do You Want to Adopt or Foster (*)	Please tell us if you want to adopt, foster or both?
How Many Children do you Have (*)	Please tell us how many children you have
How Old Are They	Invalid Input
What Breeds of Dogs Have Your Children Lived With	Invalid Input

What Best Describes Your Home (*)	Please describe your home
Do You Own Your Home (*)	Please tell us if you own your home
Does Your Home have a Yard (*)	Please tell us if you have a yard
If Adopting a Cat, Are Your Screens Secured	Invalid Input
Why Do You Want a New Pet (*)	Please tell us why you want a new pet
Is Everyone In Agreement (*)	Please Tell us if Everyone is in agreement about a new pet
Where Will Your Pet Spend Most of Its Time (*)	Please tell us where your pet will spend most of its time
If Other Please Specify	Invalid Input
What Provisions will be Made for Your pet if Alone During the Evening? (*)	please tell us what provisions will be made for your pet if alone during the evening?
What Provisions will be Made for Your Pet When You go on Vacation? * (*)	Please tell us what provisions will be made for your pet when you go on vacation?
What Gender of Pet Would You Like? (*)	Please tell us the gender of the pet you would like to have
What Age Range (*)	Please tell us the age range of the dog you are looking for
Is There a Particular Pet From the Web Site You Are Interested In	Invalid Input
What Activities do you Plan To Do with Your Dog	please tell us what activities do you plan to do with your dog?
What Circumstances Would You Give Your Pet Up (*)	please tell us under what circumstances would you give your pet up
Will This Dog be used as a Guard Dog (*)	please tell us if the dog will be used as a guard dog
Do You Have Any Pets Now (*)	Please tell us if you have any pets
If So List Type, Breed, Age and Sex	Invalid Input
Tell Us About The Pets You Have Had In The Last 10 Years	Invalid Input
Have You Had a Pet Lost or Injured (*)	Please tell us if you have had a pet lost or injured
If Yes, Please Explain	Invalid Input

Your Vets Name (*)	Please enter in the name of your vet
Vet's Phone Number (*)	Please enter in the phone number of your vet
What Persons Name is Your Pet Listed Under at the Vet (*)	Please tell us who your pet is listed under at the vet
Are Your Pets Current on Vaccinations (*)	please tell us if your pet is up to date on their vaccinations
Are Your Pets Spayed/Neutered (*)	please tell us if your pet is spayed or neutered
Are Your Pets on Heartworm Preventative (*)	please tell us if your pet is on heartworm preventative
If So What Brand	Invalid Input
When Did You Visit the Vet Last (*)	please tell us when was the last time you took your pet to the vet
	References: Please provide the name and contact information of two persons, not related to you, who are able to discuss your pet-owning abilities and overall character. This could be a friend, co-worker, neighbor First Reference:
First Name (*)	Please enter in the first name of your reference
Last Name (*)	Please enter reference last name
Phone Number (*)	Please enter in your reference phone number
Email Address (*)	please enter an email address
Street Address (*)	Please enter your references street address
City (*)	please enter in a city
State (*)	please choose a state
Zip Code (*)	please enter in a zip code
	Second Reference:
First Name (*)	Please enter in second reference name
Last Name (*)	please enter in second references last name
Phone Number (*)	Please enter in your second references phone number
Email Address (*)	please enter your second references email address
Street Address (*)	please enter in your second references street address
City (*)	please enter in your second references street address
State (*)	please enter in your second references state
Zip Code (*)	please enter in your second references zip code
	If you are adopting: We ask an adoption fee to help cover our costs of spay/neuter, all shots, microchip and transport, ranging from 150 to 200. Please let us know if you are in agreement with this.
I Agree to Pay the Adoption Fee (*)	Are you willing to pay the adoption fee
	I certify that the information I have provided on this form is true, correct, and accurate. I am financially and physically able to care for the animal that I adopt. I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreement . I understand that there is no obligation to adopt an animal to me, now or in the future. I understand that my electronically -generated signature [below] is valid as a means of legal signature for the purpose of this adoption application and a background check will be performed
I Agree That all The Information on this Form is True (*)	Please confirm all information is true
Signature - Please Type Full Name (*)	Please type in your full name
Type in Your Initials (*)	Please type in your initials
date (*)	please type in today's date
Submit Application