CODA ADOPTION APPLICATION

(Cleveland Ohio Dog Advocates)

P.O. Box 44092

Brooklyn Ohio 44144

216-200-0389

  
Name                 
Phone number

Fax Number     
Address          

City
State
Zipcode

Birth Date (8/21/1965)

E-mail

Confirm e-mail


   

Would you be willing to adopt a Dog with special needs; i.e.Deaf, Blind, older, needs surgery, needs medication, is , has behavioral problems, never lived inside a house before,etc.?
Yes No
Which dog or dogs of ours are you interested in?
Why do you want a Dog?
What other animals do you have?
Are they spayed/neutered and if not, why?        
Please list any pets you have owned?
Have you ever obedience trained (through classes) before?
Yes No
Will you train your next dog through classes?
Yes No
Does your lifestyle allow you to have the time and energy to properly care for a Dog?
Yes No
Have you or anyone in your immediate family ever been charged with cruelty to animals or child abuse?
Yes No
Are you going to be moving in the near future?
Yes No
What will you do with your Dog should you have to move?
Employer

Employer Phone #


Company Address
 
City
State
 Zipcode


How long have you worked there
What are your work hours
Occupation

Are any other family members employed?
Yes No
If you have previously owned a Dog, who did you purchase them from and what became of them?
 		List their name, occupation, work hours and company they work for:
How many adults are in your household, their names and how they are related?
If children, list their ages & sex
Is anyone in your family home during the day?
Yes No
Do you own or rent your home?
Own Rent
Does your rental agreement permit you to keep pets?
Yes No
How long have you lived there?
Landlord's name
 
Landlord's phone #
Do you have a fenced in area for your pets?
Yes No
What kind/size of fencing?
If you have a pool, is it fenced in?
Yes No Not Applicable
Where will you keep your pet during the day?

At night?
When your family is away overnight?
When your family is on vacation?
What are the leash laws in your area?
Have you ever had a dog in the past that you kept chained or penned outdoors?
Is at least one vehicle large enough to hold a Dog of the size you are applying to adopt comfortably in the cab?
Yes No
What kind of vehicle(s) do you drive
Are your pets on heartworm preventive?
Yes No
What kind? How often do you give it?
Date of last vaccinations

References:

Veterinarian's name
Phone #

 
Name and telephone number of 3 local individuals (not related) who know/have known your other animals:
Name

Adddress

Phone #

Email

Name

Adddress

Phone #

Email
Name

Adddress

Phone #

Email
May we visit your home and check references to verify the information you have provided?
Yes No
How did you learn about Coda Dog Rescue?
Signature of Applicant Date

Return to:
C.O.D.A. Dog Rescue- (Cleveland Ohio Dog Advocates)
P.O. Box 44092
Brooklyn, Ohio 44144

Or submit through the internet using this page and form




A well trained dog is a happy dog!
Website © Copyright CODA CO.I, 2002-2006