Dog Adoption Application "*" indicates required fields Date (click on calendar icon)* MM slash DD slash YYYY Dog's Name* Store Location*PetSmart – BloomingdalePetco – BloomingdalePetSmart – SchaumburgAdoption Requirements:(1) Be at least 21 years of age; (2) Have the knowledge and consent of all adults living in the household; (3) Have approval from the residence owner; (4) Have a valid ID with current address; (5) Be approved as a suitable adoptive home by Almost Home Foundation; (6) Live in the greater Chicagoland area; and (7) Pass a veternarian reference check for current and past pets.Name* First Last Name First Last Age* If you are 70 years of age or older, we require a family member to co-signDriver's License Number or State ID* Please complete your full home address, including street number and name or your application will not be processed* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneCell Phone*Email* Employment Status?* Full-time Part-time Retired Not employed How long have been employed at your present job?* Name of Employer Residence Information (residency requirements will be verified)* Do you Own? Do you Rent? Type of Home?* Apartment Condo Townhouse Single Family How long have you lived at your present address?* Any plans to move in the near future?* Yes No Do you have a fenced yard?* Yes No Fence Height If renting, does your lease allow dogs?* Yes No Is a deposit required?* Yes No Is there a weight limit?* Yes No Is your landload aware you intend to adopt an animal and have they given permission?* Yes No Landlord's Name* Landlord's Telephone Number*Name and address of Housing Complex* Will you provide a copy of your lease pet section?* Yes No List all household membersName* Relationship to you* Age* List all household membersName nnRelationship to you UntitledAge List all household membersName nnRelationship to you UntitledAge List all household membersName nnRelationship to you UntitledAge List all household membersName nnRelationship to you UntitledAge List all household membersName nnRelationship to you UntitledAge List all household membersName nnRelationship to you UntitledAge Is this dog intended for your immediate family?* Yes No Person primarily responsible for your new dog?* Any history of allergies in your family?* Yes No If so, what? What is your family's current lifestyle?* Very Active Active Moderate Often home Number of hours you work per day Number of hours your dog will be left alone per day Pet History (for pets you currently own, or have owned in the past five years)Pet Name Type/Breed Sex Male Female Age Kept where? Indoor Outdoor Spayed/Neutered Yes No Still Own? Yes No If no, what happened to the pet? Pet Name Type/Breed Sex Male Female Age Kept where? Indoor Outdoor Spayed/Neutered Yes No Still Own? Yes No If no, what happened to the pet? Pet Name Type/Breed Sex Male Female Age Kept where? Indoor Outdoor Spayed/Neutered Yes No Still Own? Yes No If no, what happened to the pet? Pet Name Type/Breed Sex Male Female Age Kept where? Indoor Outdoor Spayed/Neutered Yes No Still Own? Yes No If no, what happened to the pet? What vaccines has your current pet had in the last year? Have you ever given away or relinquished a pet to a shelter?* Yes No If yes, what were the circumstances? Have any of your pets ever been (check all that apply)? Lost Hit by a Car Put to Sleep Given Away If yes, what were the circumstances? New Pet InformationWhy do you want to adopt a dog? (please check all that apply)* Companion Companion for another animal Gift To breed For a child To teach resposibility Protection Watch Dog How many times a day will you take your pet outdoors? Will you take your pet to obdience class?* Yes No Where will the dog be kept when you are at home?* Inside Outside Garage Where will the dog be kept when you are not at home? Do you plan on using a cage?* Yes No If so, when, why and for how long? Are you aware of the general pet care costs (food, vaccines, medical care, boarding, grooming & incidentials?* Yes No Are you a Veteran?* Yes No Do you travel often for work or vacation?* Yes No How often? Weekly Monthly Yearly Who will care for your pet in your absence?* What kind of ID will be kept on the pet?* How much time are you prepared to allow the dog to adjust to your home?* What will you do in the event of:Barking problems* Aggressive behavior* Chewing/Digging* House breaking problems* How would you introduce your dog to animals in your home?* What will you do if the introductions does not go well* In case of emergency, who will care for the pet?* What veternarian (or hospital) have you used or are going to use?Name* City* Phone*Name City PhoneAre you aware of the licensing regulations and fees in your village? Yes No Do you know the leash laws of your area? Yes No Are you aware of the grooming costs for the breed that you are considering? Yes No PhonePlease list 3 references along with telephone numbers and relationship (friend, neighbor, relative)Name* Relationship* Phone*Name* Relationship* Phone*Name* Relationship* Phone*How did you hear about Almost Home Foundation? Is there anything else you would like to share with use for consideration when reviewing your application?You may want to include additional information regarding your prior pet experience, what sparked your interest to adopt at this time, and/or other information that will be helpful to our volunteers in their review process.Do you have any questions or concerns?If this dog is unavailable, would you like to be contacted about other adoptable animals?* Yes No Consent* I have reviewed The Adoption Process and What to Expect pages before completing the application.l, the undersigned certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts will result in my losing the privilege of adopting an animal from Almost Home Foundation. I realize that Almost Home Foundation has the right to deny my request to adopt an animal either because the individual animal is not suitable to my circumstances or on a more general basis. I understand that this application becomes the property of Almost Home Foundation, and all information given herein is for Almost Home Foundation’s use alone. I along with those persons accompanying me, assume risk of injury which may be incurred as a result of my viewing any animal under the care of Almost Home Foundation.Authorization to Contact* Yes No By checking “YES”, you are allowing Almost Home Foundation to contact: 1. Your veterinarian for current and past medical records on any and all pets in your household. 2. Your landlord or leasing agency in regard to pet policies if applicable. 3. Your provided references regarding the care of animals. Please be aware that by checking “No” your application will not be considered by Almost Home Foundation as per our adoption and foster policies.Signature (please type in your full name)* Date* MM slash DD slash YYYY Upon successful completion of your application, you will receive an email confirmation. If you do not receive an email, please ensure that you completed all required fields.PhoneThis field is for validation purposes and should be left unchanged.
