A Program of the Central Pennsylvania Animal Alliance
	Application to Adopt Belle Pet's Name:  First Name:       Last Name:       Spouse Name: Address:          City:                 State:              select state Alabama Alaska Arizona Arkansas California Canada Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illnois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missioui Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:         Previous Address: (complete) If less than 5 years at this address please give previous address below: Home Phone: Work Phone:  Occupation:   Spouse Occupation: E-mail:            What other dogs have you owned in the last 3 years? Breed Name Sex Alive Deceased Age Spayed/ Neutered Male Female        YesNo  Male Female        YesNo  Male Female        YesNo  Male Female        YesNo  Are your pets up to date on all shots? Yes   No   Are your pets on heartworm preventative? Yes   No Do you have other pets?   Please list them I would like to adopt a Saint for:   Please select Protection Breeding Purposes The Kids A Companion A Gift Guard Dog Obedience Work Other (CTRL click to select more than one) Other:  (Please explain below): Please indicate the following about your household: # of adults:   0 1 2 3 4 5 5+ # of children:   0 1 2 3 4 5 5+ Ages of children:   Which members of your family will feed/care for the Saint?  Does anyone in your home have an allergy to dogs?   This Saint would be alone for hours per day?  I live in a: please select House Apartment Condo Mobile Home   I/We:  Rent Own   If rent List landlord's Name:     Address:  Phone #: If you have a fenced yard, please describe it: Height of fence: Type: Size of fenced area: During the day, the Saint would be in the:  Select House Yard Garage Kennel Other Please specify other: During the night, the Saint would sleep in the:  Select House Yard Garage Kennel Other Please specify other: Are you willing to have a home check before adoption?    Yes   No Are you willing to housebreak the dog?   Yes   No Are you aware that the vet bills for routine care of a Saint may cost between $100 and $500 or More per year?  Yes   No The following is required if you have pets Name, address and phone number of current or last veterinarian: Vets Name:  Vets Address:  Vets City:  State:  select state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illnois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missioui Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip :  Vets Phone:  When you go away for a few days, who will care for the dog? Have you ever obedience trained a dog?   Yes   No   Explain what training methods and collars you prefer:  Do you realize that Saints shed profusely (especially during the summer months), often drool or slobber, and are prone to hip problems? Yes   No Are you aware that when you adopt a Saint, you are taking on the responsibility for its lifetime, which may be up to 14 years? Yes    No What specifics are you looking for in a Saint?  (If you are interested in adopting a particular dog, please specify,  and give your reason(s) for your choice): Have you owned a Saint Bernard before? Yes   No  What happened to the dog? How or where have you learned about this breed? Tell us what you're looking for: Coat length: select Long Short Sex: select Male Female Age: select Less than 1 Year 1 to 3 Years 3 to 5 Years Older Dog (CTRL click to select more than one) If you have chosen a particular dog, would you be willing to take another if your chosen dog has a medical or other problem that would prohibit its adoption at this time? Yes No Are you aware that OrganizationLongName requests an adoption fee for each adoption, to help cover expenses incurred in readying dogs for adoption? Yes  No Are you prepared to pay this fee? Yes  No Tell us about your family life: Personal References: Name: Phone: Name: Phone:
	Hounds of Prison Education A Program of the Central Pennsylvania Animal Alliance