Adoption Application

Please fill out the following adoption application completely. The adoption process is designed to match the right dog with the right family. Since looks are not all that makes a dog special, we concentrate on personality and compatibility with their new forever home. Please remember that not all Jack Russell Terriers are the same.

Please contact Jacks Galore if you have any questions regarding the adoption fee for these wonderful terriers.

Applicant
Name:
Street Address:
City:
State:	Zip:
Email:
Home Phone:
Work Phone:
Occupation:
Housing
Do you own or rent your home?	Own Rent
I (we) live in a:
Do you have your landlord's permission to own a dog?	Yes No Not Applicable
Landlord Name:	Phone:
Do you have a securely fenced yard?	Yes No
How long will your dog be left alone?	(hours)
Family
Who lives in your household (# adults, etc)?
Are there any children?	Yes No
If yes, how old are the children?
Children's relationship to family adopting:
Adoption
Describe a typical day in the life of your adopted dog with you and in your home:

Why have you decided to adopt a Jack Russell Terrier?

If you have adopted a rescue dog before, where did you adopt from and what breed did you adopt?

If you have dogs or other animals currently living in your home, please describe them (age, sex, breed, temperament, neutered/spayed):

How many dogs have you owned in the past 5 years?
If you do not still own the dog(s), please describe what happened to it (them). Please be specific.

Preferences
Sex preference for adoption:
Age preference for adoption:
Would you consider adopting a mix?	Yes No
Would you consider adopting a dog with some minor physical impairment?	Yes No
Veterinarian Information
Even if your dog has passed, we would appreciate your last vet's information below.
Do you have a regular veterinarian?	Yes No (If "No", skip this section)
Vet Clinic Name:
Doctor Name:
Street Address:
City:
State:	Zip:
Vet Phone Number:
Date of Last Vet Visit:
References and Comments
First Reference - Please include Name/Relationship/Phone

Second Reference - Please include Name/Relationship/Phone

Comments:

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