K9 SAVIOR FOUNDATION 465 BELMONT RD, MASON TN 38049 [email protected] – (901)487-1567 (Please Print) DATE ____________________________ Who are you interested in adopting & why?__________________________________________ ____________________________________________________________________________ YOUR INFORMATION NAME ______________________________________________________________________ ADDRESS ___________________________________________________________________ ____________________________________________________________________________ HOME PHONE ________________________ CELL PHONE __________________________ EMAIL ADDRESS _____________________________________________________________ MARITAL STATUS_____________________ AGE __________________________ EMPLOYER__________________________________________________________________ ADDRESS___________________________________________________________________ WORK PHONE_____________________________________________________________________ How long have you been employed there?_________________________________________ Do you rent_____ or own_____? House_____ or Apartment_____ Does your landlord allow pets? Yes_____ No_____ Will your dog live indoors? Yes_____ No_____ Do you have a fenced yard (if in a house)? Yes_____ No_____ Do you have other pets? Yes_____ No_____ Please list breeds & ages _______________________________________________________ Do you have children in your home? Yes_____ No_____ Please list ages _______________________________________________________________ 2 PERSONAL REFERENCES (not living in your household – please advise them that we will be calling your references) Name __________________________________ Phone________________________ Name __________________________________ Phone________________________ VETERINARIAN______________________________________________________________ Clinic Name________________________________ Phone____________________________ Address _____________________________________________________________________ ____________________________________________________________________________ AGENCY NOTES: Approved________________ Declined______________ Initials_________________ (copyright by K9 Savior Foundation – 2015