Kootenai Pets for Life - Dog Adoption Form 

Dog's Name: 

Pet ownership is a serious responsibility. This policy of Kootenai Pets for Life, Inc. is to assure that each person who adopts a pet is aware of the responsibility and that each is capable and willing to accept that responsibility morally, physically and financially. The pets that come into our care have been rescued once and our goal is to see that they are placed in caring life-long homes the second time around. The following questionnaire has been designed to aid both you and KPFL in deciding if you and/or your family is indeed at this moment adequately prepared to assume the type of responsible ownership which we are endeavoring to assure for our adoption animals. Please be sure to answer all questions and feel free to add your own comments.  If a question does not apply write N/A.   

 Name: 

Physical Address:

City/State/Zip:    Home Phone:

Work Phone:    E-mail:

Do you  Own or  Rent a:  house,  condo,  apartment,  mobile home,  other (describe)

Do You have your landlord's permission to adopt this dog?  Yes    No      Don't know

Landlord's Name:   Phone 

Are all adult members of the household in favor of adopting a dog?   Yes    No   Don't Know

Who will be primarily responsible for your new dog's: Training

Feeding     General Care

Do all members of your household understand that it takes time for a dog to adjust to a new environment?

 Yes,   No,   Don't Know

Which of the following characteristics are you looking for in your new dog?   Watchdog,   Family,

Companion,  Hunter,  Gift.  If gift is recipent prepared for a dog?

One of our major concerns is responsible pet ownership and that all pets be properly cared for by their owners. Are you prepared for the average monthly cost of feeding and caring for a dog of about $40 to $50 per month and possibly substantially more?  Yes,  No, I would like more information.

Where will the dog be kept during the day?   Indors,  In and Out,  At Work,  In Yard

Where will the dog be kept during the night?  Indors  Outside

Will someone be home during the day?   Yes  No  Sometimes

In order to ferify information, KPFL may want to inspect the premises where your pet will be kept. Is this

acceptable to you?  Yes  No   Don't Know

Does anyone in your household smoke?  Yes  No

 What pets do you currently have in your household?

Kind Spayed/Neutered (Yes or N0) Kept Where? (In or Out) Vaccinated  (Yes or No) Time Owned

Please list pets you have owned in the lst 10 years.

Kind Spayed/Neutered (Yes or N0) Kept Where? (In or Out) Vaccinated  (Yes or No) Time Owned

 List Children in household and ages.

Child Age Child Age

 Veterinarians Name:   Phone:

 Personal Reference (non-relative):   Phone:

Pet safety:  A county wide leash law requires that dogs be kept on a leash or secured at all times. This helps protect your dog from running loose, chasing other animals and getting hit by a vehicle. How will you keep your dog on your property?     Fence    Trolley,   Chain (not recommended),  Training,  Other (please describe)

If you plan to keep the dog outdoors, describe the outdoor shelter  Porch,   Garage,  Dog House,

  Other (please describe)

I certify that the above information is true and correct to the best of my knowledge. I understand that KPFL reserves the right to deny the adoption of any animal.

Signature          Date

FOR OFFICE USE ONLY

    Approved     Denied                                 Staff Signature                                                                                                  

Reason for denial.                                                                                                                                                                                   

Date applicant may return for animal                                              Good through