ADOPTION APPLICATION

NOTE: You must be over 21 to submit an application

Date: 04/ 01 / 2017 Dog's Name: JACK THEE HOUND

X
CONTACT INFORMATION

First Name: VALENTINA Last Name: VERANES

Street Address 1: 7 TAYLOR STREET

PO BOX Address 2:
City/State: NEW PALTZ, NY Zip: 12561
Daytime Phone: 845 419 2647 Evening Phone: 845 419 2647
Cell Phone: 718 593 7544/ 646 339 2175 Work Phone: 718 593 7544/ 646
339 2175
Place of Employment: NEW PALTZ, NY (WEW ARE SELF EMPLOYMENT)

Email: tinaveranesus@gmail>com

Spouse's/Partner's Name: ANDRES VERANES

Roommates name(s) AND TWO DAUGTHERS
1: ALICIA VERANES 2: VIOLETA VERANES
3: 4:

Why do you want to adopt a dog? Please check ALL that apply:
Family Pet X Childs pet X
I want my child to learn responsibility and a pet is a good learning experience
X
Gift : __
If gift for whom and why:

__________________________________________________________________

Hunting Dog _____ Guard dog ____________ Home X Business___________

Companion X Companion for current pet ____

Other (please specify):
__________________________________________________________________
What are you looking for in your new dog?

Breed? ANY, BUT PREFERENCE BEAGLE

Age? BABY, YOUNG

Size? MEDIUM

Other? NO

How long have you been looking into adoption? A COUPLE WEEKS AGO

How soon are you looking to adopt? A SOON IS A POSSIBLE

Current Living Situation

Do you live in: house X apartment _____ condo/town home ____
mobile home_____

Do you rent or own your home? OWN HOME

If you rent, name and contact number for your landlord:
___________________________________________
Do you have your landlords approval to have pets? _____YES
_____NO

What is the pet deposit? __________

Are there any breed or weight restrictions? NO
How long have you lived at your current address? 3 YEARS AGO
Is there a fenced yard? Yes ________ No X
If yes please indicate type of fence (height, style, etc.):
________________________
Are you planning on moving within the next two years? NO
If yes, explain:
_______________________________________________________________________

How will you provide exercise for your new pet? WE HAVE A BIG YARD
(FRONT, BACK AND SIDES) AND WE USE TO JOGIN IN THE RAIL-TRIAL WAY
NEAR AT HOME
______________________________________________________________________________
________________________________________________________
How many adults are living in your home? TWO
How many children?: TWO
Ages: 10 & 6 YEARS OLD
If you do not have children, do you have children that visit your home?
_________
Please indicate their ages: __________
Does everyone in the family know that you are considering adopting a dog?
Yes X No_____ Is there anyone in your home with pet allergies? NO
Is there any current health issues or stipulations that may effect how you can
care for a dog?NO

Do you foresee any major changes in your life in the next 15 years, (average
life span of a dog), such as marriage, children, health problems, going away
to college? If yes, explain.

NO

Pet History
Do you currently have a pet? Yes ______ No X

If you responded yes to the question above, please state what kind of pet
(dog, cat, etc.) describe the pets current circumstances and temperament:

If you currently do not have pets, but have in the past please respond to the
statement below:

Please indicate the species, breed (if applicable), sex and age of your
current/former pets. Please explain what happened to your former pets and
where they are now. Include dates etc... BETWEEN 1970 AND 1980 WITH MY
PARENTS HAD A DOGS & CATS (FEMALE & MALE). THEY DIED BY ELDERY
Have you ever had a serious behavior problem with a previous pet? NO If
yes, please describe and explain outcome.

Were all previous pets spayed/neutered? NO

How do you feel about spaying/neutering your pet? NO PROBLEMS BUT I

PREFER KEEP NATURAL
Has a dog died on your premises of distemper, parvo or unknown causes?
Yes___No X
Will this be your first dog? Yes?_____ No X
Have you ever tried to adopt from another rescue group or humane society?
Yes___ No X

If yes, what was the outcome?

Pet Care Philosophy

What type of collar/harness do you have on your dog now?
What type of collar/harness do you plan on providing for your new dog? THE
SUGGEST VETERINARIAN
What kind of preventative medical care do you or will you provide for your
dog? THE SUGGEST BY VETERINARIAN
 What would you consider a realistic cost to properly care for a dog for one
year? THE SAME AS ANOTHER MEMBER OF THE FAMILY
What is your vets name and number? WE DON'T HAVE YET, BUT WE
CONSIDER THE NEW PALTZ ANIMAL HOSPITAL . 845 255 5055
Or past vet?
__________________________________________________________________
Are your current animals up to date on vaccines? Yes________ No_________

Daily Routine
Approximately how long will the new dog be alone during the day? A COUPLE
HOURS, AS WE TAKE WHEN WE GO TO THE RESTAURANT.
Where does your current or where did your past dog stay during the day
when you are gone?
Goes to work with me ______ Outside in a fenced area _____
Outside in a dog pen _____ Outside on a chain or stake _____
In a crate indoors _____ In the basement _____
Free run of the house X
Indoor/Outdoor (has access to the yard via a doggy door)_____
Other (please describe): ___________________________________________

Where will the new dog stay when you are gone during the day?
Goes to work with me ______ Outside in a fenced area _____
Outside in a dog pen _____ Outside on a chain or stake _____
In a crate indoors _____ In the basement _____
In the garage _____ Baby gated in one-two rooms _____

Free run of the house X

Indoor/Outdoor (has access to the yard via a doggy door) _____
Other (please describe): ___________________________________________

Will your dog be allowed on the furniture? Yes_____ No X

Certain pieces _______
Where does your current or where did your past dog sleep at night?
In a crate in the bedroom _____ Your bed _____
Doghouse in fenced area _____ Doghouse with tie-out _____
Basement _____ Garage _____
Free run of the house X One room in house _____
Where will your new dog sleep at night?
In a crate in the bedroom _____ Your bed _____
Doghouse in fenced area _____ Doghouse with tie-out _____
Basement _____ Garage _____
Free run of the house X One room in house _____

What percentage of time will the new dog stay in the house? 100%
Where will the dog stay when you go out of town? WTH US IF IS FOR LONG
TERM, IN HOME IF IT IS BY COUPLE OF HOURS.
Are you aware of state and local ordinances concerning pet licensing and
leashing? Yes X

No __

I would allow my dog off leash in the following situations:

In a quiet subdivision ____ On unfenced property with a lot of acreage _____

At the beach ____ Invisible or electric fence _____

When I know that s/he is trained to stay within the set boundaries X
Never _____

House Breaking and Training

What type of house training methods will you use?
___________________________________
Do you have any experience crate training a dog? NO
If you dont have a crate, will you be willing to purchase one if the new dog
needs to be crated?
YES__________________________________________________________________________
____
Will you enroll this pet in obedience training? Yes X No_____

How would you handle adjustment/training problems such as:

Jumping on furniture AS THE OBEDIENCE TRAINING SUGGEST

Jumping on People AS THE OBEDIENCE TRAINING SUGGEST

Barking AS THE OBEDIENCE TRAINING SUGGEST

Chewing AS THE OBEDIENCE TRAINING SUGGEST

House Soiling AS THE OBEDIENCE TRAINING SUGGEST

If your adopted pet develops behavioral problems or other unacceptable

habits what will you do? (Example: Seek professional help, enroll in puppy
school, return to rescue, etc. )

SEEK PROFESSIONAL HELP

Special Circumstances
You would rehome your adopted dog in the following situations Check all
that apply :
____ Moving ____ New baby, no time for dog
____ Not getting along with other pets ____ Divorce
____ Getting out of fence ____ Behavior problems
____ Shedding ____ Children not helping to care for
dog

____ Increased work hours ____ Allergies

____ Not housebroken ____ Medical problems
____ Barking ____ Gets too big
____ Not getting along with children ____ Aggressive
____ Want to travel ____ Not enough time for the
dog

Other______________________________________________________________
X None of the above

Have you ever given a pet up? If yes, explain the circumstances.

Most pets require time to adjust to their new home. How much time are you
willing to give this pet? ALL IT IS NECESARY

Please provide three personal references (not relatives) : Please give all
area codes.

Name ALEXANDRA WEBB Phone no. 917 250 0573

Name SARA HSU Phone no. 845 245

7240

Name JOE DOLAN Phone no. 845 332

8991