Name ______________________________________________________Co-Applicant
__________________________________________________
Address
__________________________________________________________________________________________________________________
City ________________________________________________________________State
__________________Zip Code ______________________
Phone: Home (_____) ____________________________ Best time to call: _______________________________________
Work (_____) _____________________________ May we contact you at work
if needed? YES
NO
E-mail
Address: _________________________________________________________@___________________________________
Occupation/Employer
(optional)________________________________________________________________________________
Number
of people in your home _____________________ Ages (children only) and relationship ________________________________________
Your household activity level is (circle one):
QUIET AVERAGE
VERY ACTIVE
Is there anyone in your home with known allergies to dogs? __________________________________________________________
Would you object to a home inspection by a PGC, Inc. representative?
YES NO
Describe the area in which you live (circle one): City Suburban
Rural
House Apt
Townhouse OTHER
______________________________
Do you (circle one): Rent
Own If renting, landlord's name and phone number: __________________________________________________
__________________________________________________________________________________________________________________________
Do you have a fenced-in yard? YES
NO Type of fence (height, type, condition) (NO INVISIBLE FENCES)
____________________________________________________________________________________________________________
If you
do not have a fenced-in yard, are you committed to walk your Greyhound ON LEAD 3-5 times a day? YES
NO
Are you aware of the importance of always keeping your Greyhound on a leash if not in an enclosed area? YES NO
How many
hours will your Greyhound be home alone each day? ___________________
Where would your Greyhound be kept while you are not home? ____________________________________________________________________
Are you willing to crate your Greyhound during his transition into your home for as long as necessary? YES NO
Do you understand and agree that your Greyhound must always
live in the home's living quarters (not the garage or unfinished basement) and cannot be kept in an outdoor kennel or doghouse? YES NO
Do you
have any preferences regarding sex? MALE FEMALE DON’T CARE
Would
you consider adopting a senior (6 or older)? YES
NO Track injured Greyhound? YES NO
Daily Medicated Greyhound? YES
NO
Do you understand
and agree that if you cannot keep your Greyhound for any reason, it is to be returned to PGC, Inc. without obligation on our
part to refund any portion of the adoption fee? YES NO
Are you willing to accept immediate and full responsibility
for ownership of your Greyhound, including all health care costs not covered by the adoption fee and all other responsibilities
of pet ownership? YES
NO
If your
application is approved, when is the earliest date you would be able to take possession of your Greyhound? ________________________
____________________________________________________________________________________________________________________________
Why do you want to adopt a Greyhound? _________________________________________________________________________________________
____________________________________________________________________________________________________________________________
How did you hear about the Philadelphia Greyhound Connection, Inc. adoption program? ______________________________________________
____________________________________________________________________________________________________________________________
Do you currently have any dogs in your
household? __________ Please list: (breed, age, sex) ___________________________________________________________________________________________________________________________
Are they current on their vaccinations, i.e., rabies,
etc. YES NO
Are they spayed/neutered? YES NO If no,
why not? _______________________________________________
Do you currently have any cats in your
household? __________ Please list: (breed, age, sex) ___________________________________________________________________________________________________________________________
Are they current on their vaccinations, i.e., rabies,
etc. YES NO
Are they spayed/neutered?
YES NO
If no, why not? _______________________________________________
Are they cats: HOUSE CATS
OUTSIDE CATS Declawed: YES NO
What other pets are in your home? _____________________________________________________________________________________________
Do you agree to provide yearly vet
exams and up to date vaccinations: YES
NO
Do you agree to use heartworm preventative
all year? YES
NO
Do you agree
to take your Greyhound to your own Veterinarian within two weeks of your adoption for a well check-up? YES NO
Have you ever returned a pet to an animal shelter/humane society?
YES NO
If so, why? _______________________________________________________________________________________________________
Have you
ever applied to another adoption group? _____________________________________________________________________
Was your application approved? YES
NO If not, why? _______________________________________________________________
________________________________________________________________________________________________________________
REFERENCES
Our first
check is with your veterinarian to confirm that your other pets are current on vaccinations and are receiving heartworm preventative
medication.
Veterinarian’s Name: _______________________________________________________ Phone: ________________________
Address: ________________________________________ City: _____________________ State: _________ Zip: ___________
Records are under what name: ______________________________________________________________________________
We also require 3 personal references, e.g., neighbor, co-worker, dog
trainer, pet sitter, etc. Please provide names and phone numbers:
(1)__________________________________________________________________________________________________________
(2)__________________________________________________________________________________________________________
(3)__________________________________________________________________________________________________________
PLEASE
READ CAREFULLY BEFORE SIGNING: I certify that I fully understand the above questions and all answers/information given are true and correct. I authorize
my veterinary reference to release any and all information regarding services provided, or lack thereof, involving all animals
in my care, past or present. I have enclosed with this application a $50.00 processing deposit (DO NOT SEND CASH), which will
be applied to the $260.00 Adoption Fee if the application is approved. I understand and agree that if my application
is rejected for any reason, I will receive a refund of $50.00. I further understand and agree that if I do not go through
with an approved adoption when informed that the dog is ready, the adoption process will be terminated and no refund will
be made.
Signature____________________________________________________________________
Date_________________________
