APPLICATION FOR DOG ADOPTION Thank you for adopting. In 2020 we have had an overwhelming number of applications. We now have a $10 application fee which helps to cover our administrative expenses of processing. The application fee is non-refundable. We do ask what pet you are interested in; BUT please note we cannot guarantee that pet will still be available once you are approved. Once approved your application is good for six months and you will have a meet and greet with pets we do have available at that time. We will do our very best to match you with a pet. Please feel free to call us or email us for the status of your application if you do not hear back within 48-72 hours. 603-635-4495 or firstname.lastname@example.org Adoption Application feeTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Applicant Name:* First Last How did you hear about us?Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneEmail* Enter Email Confirm Email Employer:Occupation:What type of pet are you interested in?* Dog Cat What type of pet are you interested in? Puppy/Kitten <12 mos Adult 1-6 Senior 7+ years Name of pet you are interested in:Personality type:Other Preferences:How many people currently reside in your household?Please enter a number from 1 to 50.Any children in the household?None12345678910For Whom are you adopting the petSelfGiftDoes any member of of the family have allergies to animals?YesNoIf yes, explain:Who will be responsible for the pet's care?Where do you live?ApartmentCondoFarmMobile HomeTownhouseHouseDo you own or rent your residence?OwnRentIf you own, we require proof of home ownership, which can be a tax bill or proof of purchase. Please upload below.Accepted file types: jpg, gif, png, pdf.A tax bill or proof of purchase. If your attachment is too big, please email it to DDD@darbster.netIf you rent, what is name of landlord and phone number?Are pets allowed?YesNoNot SureWhere will the pet be kept?Indoors onlyOutdoors onlyBoth in/outIf outdoors will pet be?attendedunattendedcollar and tags?Will anyone be home during the day?YesNoHow many hours will the pet be left unattended?Please enter a number from 0 to 24.When no one is home, where will the pet be kept?Is your yard fenced in?YesNoIf adopting a cat, do you plan to declaw? Yes No Not Sure If you move, what will you do with the Pet?How far from the road/traffic is you home/farm located?What is the volume of traffic?LightModerateHeavyHave you ever had a pet before?YesNoDescribe the pets you still care for or that you have had in the last 5 years.NameBreedAgeNeutered?Time in your careUp to Date Vaccinations If the animal is no longer in your care, please explain:Are your pets current on their vaccinations?YesNoPlease provide name of your veterinarian:Veterinarian Phone number:Personal References:NamePhone NumberYears known Are you financially able and willing to provide annual checkups, vaccinations, and ANY medical care necessary? (Pets can live upwards of 15 years.)YesNoWhat precautions would you take to properly introduce a new pet into your home if you have other animals (a dog, bird, rabbit, cat, etc.)?What will you do if your new pet does not get along with your present pets?Have you ever adopted an animal from a rescue/animal control agency?YesNoWhy do you want to adopt a pet?Are you familiar with your local animal control laws?YesNoAre you willing to sign legal pet adoption papers?YesNoDo you agree to permit a visit to your home/farm by appointment?YesNoUnder which circumstances would you give your pet away or surrender to a shelter? Please select all that apply. If not listed, please indicate under “Other”. Not Obedient Enough Illness in family Pet became ill Moving New Baby Shedding too much Barking Chewing Too energetic Doesn’t get along with other dogs Divorce Got a new pet Allergies Housetraining problem Bit Someone Kids ignore pet Pets not getting along Got too old Doesn’t like all people Would not give pet away at all Pets on furniture If other is selected above please describe:Have you ever surrendered a pet to a shelter? Yes No If Yes, why?By signing this form, l/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact may result in Darbster Foundation refusing adoption privileges to me/us. If my/our request for adoption is approved and later Darbster Foundation discovers the above information is not true or correct, Darbster Foundation reserves the right to remove the adopted cat from my home/farm. If you have exhausted all reasonable efforts to keep your pet, Darbster Foundation accepts the return of any animal adopted from our facility. Adoption returns must be scheduled in advance and are accepted by appointment only. Guardians who wish to return their adopted animal should call 603-635-4495 or email email@example.com to schedule an appointment. Note- there will be an intake fee of $75 if the dog is returned after 14 days from the original adoption date. SignatureDate Date Format: MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.