Return home Adopt Dog Adoption Application Portage APL Dog Adoption ApplicationWe reserve the right to approve or disapprove any adoption.Email Address* Adoption Consent & Requirements*I understand that in order to be considered for an adoption from Portage APL, I must: - Be at least 18 years of age - Have the knowledge and consent of all adults living within my household - Have proof of landlord's consent to bring an animal onto the property I agree to these adoption requirements.Name of the dog you are interested in adopting: Do you have a fenced-in yard or area? Yes No No, but we are having one installed Are there children in the home or that visit the home?* Yes No HiddenIf yes, please list ages of children:* How often are children in the home?* Have younger children (ages 10 and under) in the home been taught how to properly interact with dogs?* Yes No Is any household member allergic to dogs?* Yes No If yes, someone is allergic, how will they deal with reactions to this dog?*What are the reasons for wanting to adopt a dog?* Companionship Child's pet Family pet Playmate Companion for another pet Guard Dog Gift Hunting Dog Other Please check all that apply.If 'Other', please explain:* Are there other animals in your home?* Yes No If yes, tell us a little about your other animals.*(i.e. Type of animal, ages, personality, how long you've had them, etc.)Have you had a pet that had Canine Distemper, Parvovirus, any other contagious disease or has died from an unknown cause in the last six months?* Yes No Do you have a veterinarian that you visit regularly?* Yes No If yes, please give the vet's information:*Please include vet's name, name of their practice, phone number and address.What is your dog experience?* First time dog owner Owned multiple dogs Owned dogs who have required training Owned dogs with behavioral and training problems In the past have you owned dogs that have not worked out for you?* Yes No Do you know the life expectancy of a dog may be 15+ years? Are you willing to take responsibility for your dog's entire life?* Yes No Which best describes your living situation?* Renting a house Apartment Condo Live with parents Mobile home park Own my own home (Please check all that apply.)If renting, please list the name and phone number of your landlord: Who will be the primary caretaker of the dog?* If you should ever move or experience significant life changes, what would you do with this dog?* Where will the dog stay during the daytime (i.e. working hours)?* Where will the dog stay during evening hours?* Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Best number to contact you at.Today's Date* MM slash DD slash YYYY The date you are filling out this application.Application Submission & Consent*This application is designed to help us determine if the adoption is in the dog’s best interest, and to assist you in finding a compatible pet for your lifestyle. An unwise adoption can result in an unpleasant experience for both the adoptive family and the pet and may ruin the pet for future adoption. We hope you agree that the pet’s welfare MUST BE OUR FOREMOST CONCERN. We reserve the right to examine the adoptive situation and decide what is best for the pet's overall quality of life. Our goal is to ensure a forever home for each pet that is adopted and a conducive life for the pet involved. I understand these goals and agree to them. I also understand that misrepresentation or omission of facts is cause for denial of adoption. I understand the above questions and I authorize investigation of all statements contained in the application. By signing this application, I am stating that the above mentioned is true. (Please initial below) CommentsThis field is for validation purposes and should be left unchanged.