Application for Purchase/Adoption

Please fill out this form if you are interested in purchasing or adopting a puppy, dog, or horse.
Please fill out the entire application, an incomplete application will not be considered, if the field does not pertain to you, please enter N/A in that field
What are you interested in doing? 

Name of the animal you are interested in: 

Please tell us a little bit about yourself

 
Your Name: 
Your E-Mail Address: 
Your Phone Number: 
Your Fax Number: 
Your Street Address: 
Your City: 
Your State: 
Your Zip Code: 
Are you over 18 
Regarding your current residence, do you:  
If you rent, Please provide the name and telephone number of your Landlord.
Landlords's Name: 
Landlord's Phone Number: 
What Breed are you interested in? 
What sex are you interested in?: 
What age range are you interested in?: 
(Check all that apply:)
Puppy only (under 6 months)
Young Adult (6 mos. - 3 yrs)
Adult (3 - 6 yrs)
Senior (7 - up)
Any Age
What characteristics do you expect in your new Dog?:
(Check all that apply:)
Active
Playful
Independent
Protective
Dominant
Shy/docile
Good with kids
Calm
Intelligent
Loving
Aggressive
Submissive
Outgoing/friendly
Good with other pets
Other
Do you have other pets? 
If Yes, Please explain:
Do you have any Children? 
If Yes:
  • How Many 
  • What are their Ages 
  • How Many adults live in your home 
    • Does everyone want this dog 
    Do you have a fenced yard? 
    What type of fencing (style, height, etc)?
    If yard is not fence, would you be willing to fence, or how do you plan to exercise the dog?
    Obedience classes are highly recomended for your new pet, are you willing to take him/her to class 
    If NO please explain?
    How long will the dog be left at home alone?  
    If more than six hours or longer in the question above, what provisions will you make for the dog to relieve itself and get exercise during your absence?
    If Dog, where will the pup/dog be kept when your not home?
    If horse, where will the horse be kept?
    Anything else you want to add

    Please provide the name and telephone number of your Veterinarian.

    Vet's Name:
    Vet's Phone Number:

    Please provide your employers name, address, and phone.

    Employer's Name:
    Employer's Phone Number:
    Employer's Address:

    Please include references from several people who are familiar with you, your animal(s) and your experience.

    Name:
    E-Mail Address:
    Phone Number:
    Name:
    E-Mail Address:
    Phone Number:

    As a part of the adoption process and before placing any dog, you will be asked to sign a contract in which you agree to certain conditions. Such as allowing a KRPetz - Omega Refuge & Working K9 representative to visit your home before and after placement of the dog, and finally, surrender back to KRPetz - Omega Refuge & Working K9 of the dog if you violate the contract or are unable to keep the dog for any reason. Are you willing to sign, and be bound by, such a contract?  

    I/we have read and carefully answered each question on this Adoption Application and have provided truthful answers. I/We understand that KRPetz - Omega Refuge & Working K9 will rely on the answers we have provided in going forward with the adoption process, and in the event that KRPetz - Omega Refuge & Working K9 learns that false information has been given, we may be denied the right to adopt a dog and/or any dog placed in our care by KRPetz - Omega Refuge & Working K9 may be required to be returned to KRPetz - Omega Refuge & Working K9. We also give KRPetz - Omega Refuge & Working K9 permission to contact our vet, landlord, and/or personal references.
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