Dog Application GHP Dog Application GHP Dog Application I am applying to (must be 21 years of age or older): * Adopt Foster If you are applying for a specific dog, name of the dog: First Name * Last Name * Age * Phone Number * Email * Address * City/Town * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code * How long have you lived at this address? * How many times have you moved in the last 5 years? * Co-Applicant's First Name Co-Applicant's Last Name Relation to Applicant Do applicant and co-applicant live together? Yes No I/We live in a * House Townhome or Condo Apartment Trailer or Mobile Home Do you * Own Rent or lease Live with a parent or relative Other If you rent or lease, are you allowed to have pets? Yes No I'm not sure If you rent or lease, is there a limit to the number of pets allowed? Yes No I'm not sure If you rent or lease, amount of pet deposit: Has the pet deposit been paid? Yes No I am planning to pay the deposit if my application is approved Name of Landlord/Apartment Complex Landlord/Apartment Complex Phone Number Are you willing to allow a representative of Georgia Homeless Pets to visit your home (by appointment)? * Yes No If no, why not? Employment Status: * Working Homemaker Unemployed Retired Attending School Other Employer's Name Occupation Work Phone Number Work Hours: Please check any of the following reasons for adopting this dog that apply * Family Pet Child's Pet Companion Companion for another Pet Guard dog Other Will this dog be a surprise for anyone? * Yes No Is everyone in the household in favor of adopting/fostering this dog? * Yes No Name, age and relationship of any other adults living in the household (N/A if not applicable) * How many children live in your household? * What are the ages of the children (under 18) living in your household? How will you handle the introduction/interaction between the new dog and your child(ren)? (N/A if not applicable) * Are any members of your household allergic to dogs? * Yes No If any household members are allergic to dogs, what will be done to accommodate the dog and the household member? How many pets do you currently have? * Please list the names/ages/type of pet of all current pets (N/A if not applicable) * Are all of your current pets spayed/neutered? * Yes No Current pet is too young to spay/neuter yet I don't currently have any other pets Are all of your current pets up-to-date on vaccinations? * Yes No The vet does not recommend vaccinations for my pet I don't currently have any other pets Do you or any of your household members smoke or vape? * Yes No Only outside If you or anyone in your household has a serious or life threatening illness, please explain. (N/A if not applicable) * What do you consider an appropriate amount of time for a new dog to adjust to a new home? * Who will be responsible for the daily care of the new dog? * Does the primary caretaker(s) travel often? * Yes No When traveling, who will take care of your pet(s)? * Please list any other pets you have owned as an adult (name/type of pet/how long you had pet/what happened to pet/age of pet when you last had him or her) Veterinarian's Name (N/A if you have not owned a pet in the last 5 years) * Veterinarian's Phone Number How much do you expect to spend on your dog annually? * Are you familiar with heartworm disease? * Do your current dogs/ did your past dogs receive monthly heartworm and flea preventative? * If your dog develops an expensive medical problem, what will you do? * Is your yard fenced? * Yes No Do you have a swimming pool in your yard or accessible to your dog? * Yes No Do you have a pet door? * Yes No What is the maximum number of hours your dog will be left alone in a typical day? * Where will the dog be kept or stay when you are not home BEFORE being house trained? * Where will the dog stay when you are not home AFTER being house trained? * Where will the dog sleep BEFORE being house trained? * Where will the dog sleep AFTER being house trained? * What methods will you use to house train your dog? * Have you ever had a serious behavior problem with a pet? If yes, please explain the problem and how it was handled. * Have you ever given up a pet? If yes, why? * What circumstances, in your mind, justify giving up a pet? Check all that apply. * Allergies Personal medical issues Pet has frequent or expensive medical issues Pet is ruining the floors or the furniture Shedding Aggression Moving Personal issues (e.g. divorce, job loss etc.) Doesn't get along with other pets I would not give up a pet under any circumstances Other What will you do with the dog if one or more of these circumstances should arise or if you should become unable to care for the dog for any reason? * Please explain any major changes you forsee in your life over the next 10-15 years (e.g. marriage, divorce, baby, job transfer etc.). * Have you applied for a pet with another rescue group in the last 3 years? If so, which groups? * Can you provide a permanent, loving home for this pet for the next 10 to 15 years? * Please provide the name and phone number of two references. * By typing my name below and submitting this application, I am attesting to the truthfulness of my answers.Falsification of any of the above information will be grounds for disallowing the adoption of the rescue pet and possible removal of said pet from my home. I consent to Georgia Homeless Pets representatives discussing information on this application with any persons named on this application. I am also affirming that I am 21 years of age or older. I understand that Georgia Homeless Pets has the right to refuse any applicant for any reason and that all applications become the property of Georgia Homeless Pets. * Date (please use format 99/99/9999) * Submit If you are human, leave this field blank.