On-Line Dog Adoption Pre-Screening Form

Thank you for considering to adopt a dog from our shelter. PLEASE READ THIS FORM CAREFULLY. This on-line form is intended to assist you in selecting a dog that is suitable for you, your family, and your lifestyle.

The Friends of the Plymouth Pound have established guidelines and policies that must be met in order for your pre-screening application to be approved. The information you provide is essential to facilitate the application review process.

In order to be considered for adoption by the Friends of the Plymouth Pound, you must:

Be at least 18 years old.
Have no children in your household under 7 years of age. THERE ARE NO EXCEPTIONS TO THIS POLICY.
Provide all the applicable information requested below. Note, any data field marked with an asterisk character (*) must be filled in. Incomplete application forms will not be considered for review and will be denied automatically.
Understand that this is a pre-screening form. The Friends of the Plymouth Pound will contact you and approve you if, and only if, all requirements have been met.

Upon review of your pre-screening application, you will be contacted by the Friends of the Plymouth Pound to notify you if your application has been accepted and if further information is needed. Please note that we do contact all personal references and veterinarians, and we must speak with them personally. In addition, in some cases, a pre-adoption home visit may also be required. In the event that your pre-screening application has been not been approved, we will notify you of same.

THE BOARD OF DIRECTORS OF THE FRIENDS OF THE PLYMOUTH POUND RESERVES THE RIGHT TO DENY ANY PRE-APPLICATION BASED ON THE ORGANIZATION'S ESTABLISHED STANDARDS AND POLICIES, INCLUDING, BUT NOT LIMITED TO, INCOMPLETE INFORMATION, NON-DISCLOSURE OR OMISSION OF PERTINENT FACTS, AND NON-COMPLIANCE WITH ACCEPTED STANDARDS.

Upon approval of your application and transfer of the animal, you will be charged a $200.00 adoption fee per dog. Also, if you want us to hold a particular dog for you while your application is being processed, you will be charged a non-refundable $50.00 deposit. The deposit will be credited towards the full $200.00 adoption fee when you actually adopt the dog.

We are an all-volunteer organization. Due to the high volume of applications, we ask that you be patient in waiting for a reply. Please do not submit duplicate applications or separate requests for response. Doing this will not accelerate the review process in any way.

Section 1: Personal Information
*Your Name :**
*E-mail Address :**
*Street Address :**
*City :**	*State : Zip:**
*Home Phone :**
Occupation:	Work Phone:
Is this Application for : Adopting a Dog or Fostering a Dog
Why do you want to Adopt a Rescued Dog?

Are you interested in Adopting or Fostering a Dog: Immediately in the Near Future or Undecided at this Time
Can you commit to picking up the Dog you have applied for within seven (7) days of Approval? Yes No
Do you currently have applications with other shelters? Yes No
Are you currently on a "Wait List" for a Dog? Yes No - - - If "Yes", how many Applications?
Are you aware of and willing to comply with our "return policy", which states that if at any time you are unable or unwilling to keep the dog, you agree immediately to contact the Friends of the Plymouth Pound and return the Dog to our custody? Yes No

Section 2: References
Please provide the contact information for a veterinarian you have used before and plan to use with your new dog. Vet references are checked.
Vet's Name:	Phone:
Vet Records in Name Of:
Please provide at least two personal references. Include their names, telephone numbers, and tell us how these people know you and your ability to provide a good home for a dog. Note, references must be familiar with your experience with animals and they can't be relatives.

Section 3: Household Information
Please list current places of employment for yourself and your spouse, if applicable. Include the location of each employer.
My Employer:
Spouse's Name:
Spouse's Employer:
Residence:	Own Rent
If you indicate that you own, proof of ownership will be required to complete the adoption process. If you indicate that you rent, you must provide your landlord's contact information below so we may verify that you are allowed to have a dog.
Landlord's Name:
Landlord's Street Address:
Landlord's City:	State: Zip:
Landlord's Telephone:
List all the people who currently live at this residence, including yourself. Please include their names, relation to you, and their ages.

Does anyone who lives with you have a known allergy to dogs? No Yes
List any cats, dogs, or other animals that currently live in your household. Please provide the name, breed, age, sex, whether or not they have been spayed or neutered, how long you have owned the pet, and if it is kept indoors.

Section 4: History

Have You Owned a Dog Before? Yes No

If you have owned a dog before, please provide a brief history of what happened to it. If your last dog died, please state the cause and the date it died.

Section 5: Dog Information
Is this application for one or more of our currently available dogs? Yes No
If yes, please list the name(s) of the dog or dogs for which you are applying:

If no, please let us know what type of dog you are looking for. If you have a preference as to sex and size please indicate that also.

What is the oldest dog you will accept?
Will you accept a dog with treatable medical problems, i.e. needs pills?
No Yes Maybe under the following conditions:

Do you have a fenced in property? Yes No
If you have no fence, how do you plan to have your dog relieve itself?

Do all adults in your household work full time? Yes No
How many hours per day will your new dog be left alone?
Where will your dog be kept when it is left alone?
Where will your dog sleep?
What sort of training do you plan to provide your new dog?

Section 6: Donation Information

The adoption donation is $200.00 per dog. This donation covers the cost of care, spaying or neutering, transportation, shots, and to help defer the special costs associated with caring for our special needs dogs. All dogs are spayed or neutered and given all shots prior to adoption. A non-refundable $50.00 deposit is required to hold a dog.

Are these terms acceptable to you? Yes No

Please understand that dogs need veterinarian care throughout their lives, including yearly booster shots, heartworm shots, and flea/tick preventative medications. If you cannot afford this donation, you may not be able to afford the cost of appropriate veterinarian care. Please consider this before adopting a dog.

Are these terms acceptable to you? Yes No