Which A4TA dog/s are you interested in adopting? What made you interested in this particular dog/s? Name: DOB: / / Address: Home Phone: Email: City: Cell Phone: Employer: Spouse/Partner: DOB: / / State: Work Phone: Occupation

Please list names, ages and relation of everyone else living in household excluding spouse/partner:
Name Age Relation

Have you or anyone else in your household ever been charged or convicted of animal cruelty? If yes, please explain.
OWN:____ RENT____

If renting does lease allow dogs?: YES____ NO____


How many hours will your Dog be left alone during the day? Where will your Dog be kept when alone?
___Outside ____Crated ____Free Roam of House ____Enclosed Kitchen ____Basement ____Other, please explain: We expect you to commit to caring for this dog for the remainder of its life. If you can not keep the dog for any reason, you MUST return it to All 4 The Animals. You may not give it to a family member or a friend. Are you willing to agree to this and be legally bound by signing the All 4 The Animals adoption contract upon adopting a dog? Yes_____ No_____

The average life expectancy of a dog is 10 to 15 years. We hope by best matching a dog to you & your family, we are placing the dog for the rest of its life! 1. Why do you want a Dog? 2. Are there any particular breeds you like best? 3. Who will be the primary/sole caretaker of the Dog? 4. Does anyone in your family have allergies to dander/hair?
5. How much will you budget ANNUALLY for your dog? Veterinary $__________ Food, supplies, etc: $__________

6. Do you know what causes Heartworm in dogs? 7. Will you give your Dog Heartworm Preventative EVERY MONTH?
___YES ___NO

8. Will you give your dog flea and tick preventative EVERY MONTH?
___YES ___NO

9. How do you plan to exercise your Dog? 10. How much time do you have each day to exercise/ play with your Dog? 11. Who will care for your Dog while you are on vacation/travel?
12. Approximately how many weeks a year are you away from home on business or travel? ___0-2 weeks ___3-4 weeks ___5-6 weeks ___7+ weeks


13. What types of issues/problems do you anitcipate you may have with a new dog or puppy?

14. How will you encourage and reinforce appropriate behavior and deal with potty training? 15. Are you willing to have your dog spayed/neutered? 16. What will you do with your Dog if you have to move?
___Find New Home ___Take Dog on move ___Take to local Animal Shelter ___Return to A4TA ___Other 17. Have you ever had to give up a Pet (Dog/Cat/Other) for any reason? __________ __________ ___YES ___NO

18. What reasons would cause you to return the dog to All 4 The Animals Rescue?

Please list the animals you currently have: Type Breed Sex Age Spayed / Neutered Current on Vaccinations Kept where?

Please list the animals you have had in the past (do not include family pets from childhood): Type Breed Sex Age Spayed / Neutered Where is the animal now? How long did you have it?

What Vet will you use in this area? Vet Name Address Phone

Please provide three references below: Name Address Phone Relationship Yrs Known

By submitting this application, I certify that the information I have provided is true and correct to the best of my knowledge. I understand that false information may void my application. I understand that All 4 The Animals reserves the right to reclaim the dog should there be validated suspicions of abuse or neglect.

Thank you for taking the time to fill in our adoption application.

All 4 the Animals Rescue 1940 Willow Lane, Woodbridge, VA 22191 (703) 491-5294,