Adoption Application

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Date	Applicant Name	Spouse/Roomates Names
Address		City, State, Zip
Email Address		Home Phone Work Phone
DOB	Driver's License #	State DL Issued
Have you contacted another rescue group? Yes No		If Yes, Group Name
Contact Person		Rescue Group Phone #
*Experience/Knowledge*
Have you owned dogs before?	Yes, If Yes, How Many? No
Have you owned	Large Medium Small	What Breeds?
Have you ever owned an Akita? Yes No
What Happened to them?		Why do you want an Akita?
List the traits you admire in an Akita		If possible, list the traits that make an Akita a challenge to own?
What age range are you looking for?
Sex Preference? Male Female No Preference		Why?
Describe two pet behavior problems you have worked through and how you solved the problem. (soiling in the house, pulling on the leash, won't come when called)
Check any of the following that you would use to train a dog to heel or walk on a loose lead. Leash Correction Praise Food/Treats Toys Verbal Correction Comments on the effectiveness of the above?
Have you ever taken a dog through a pet training class Yes No		Do you have access to an obedience training club/group Yes No
Will you take the Akita to obedience training Yes No
*Did You Know..........?*		Akitas cannot ever be off leash in an open area (such as a park, street, unfenced yard) Yes No
Akitas have strong prey drive and can injure small animals such as rabbits and cats? Yes No		Akitas should not be tied out in the yard? Yes No
Akitas are large, strong, stubborn and independent? Yes No		Akitas blow their coats twice a year? Yes No
Akitas are naturally dominant and need to go to obedience training with the owner? Yes No		Akitas normally live to be 10-15 years old and need a commitment for that long? Yes No
Do you still think an Akita is the right dog for you? Yes No
*Home and Family*
How long at the present address? years months		Do you Rent Own your home?
If renting, does the lease permit large dogs in the house and yard? Yes No		Landlord Name Landlord Phone
Any plans to move in the future? Yes No		If yes, Where and When?
Size of Lot		Fence material and height
Do you own a crate? Yes No		Are you willing to purchase a crate? Yes No
Do you own a kennel? Yes No		Are you willing to purchase a kennel? Yes No
Are you willing to consent to a home check by a WAG representative? Yes No
Number of people in the house Number of Children Children's ages		Are the children dog-trained? Yes No N/A
Is anyone allergic to dogs? Yes No		Anyone afraid of large dogs? Yes No
How do the children react to dogs?		Will the Akita be in contact with other children? Yes No Explain
Other Pets in the house? Dogs Cats Birds Other N/A		Other animals? Yes No
Potential problems with current pets?		Will the Akita be in contact with other pets/animals? Yes No Explain
*Daily Routine*
How much time will be spent with the Akita daily Weekdays Weekends		How many hours will the Akita be left alone daily? 0-2 hours 2-4 hours 4-8 hours 8-10 hours
Where will the Akita be when you are at work?		Where will the Akita sleep?
When will the Akita be outside?		Will the Akita be tied out? Yes No
How often will the Akita be walked?		Where? By whom?
How often will the Akita be played with? By whom?		How often will the Akita ride in the car?
Will the Akita be crated or restrained Yes No How		Where will the Akita be when you are away overnight?
Unusual circumstances the Akita will need to adapt to?		Other comments regarding daily routine
References
Employer Name		Phone
Street Address		City, St, Zip
Years at present job
Current Veterinarian		Phone
Local Animal Control		Phone
Current Dog Trainer		Phone
Personal Reference		Phone
Personal Reference		Phone
Applicant Disclosure
Do you feel financially able to care for an Akita for it's lifetime		Do you feel physically able to care for an Akita for it's lifetime?
Have the police of local animal control authorities been at your house for any animal related issues?		Please note any additional information regarding your home that has not been covered in this document?
Have you reviewed WAG's adoption contract		Are you willing to sign WAG's adoption contract?
The information I have provided in this document is correct and true to the best of my knowledge and I have not withheld any pertinent information. I understand that any misrepresentation of myself or my family or any untruths in the information I have provided herein that are discovered at a later date will invalidate any adoption agreement and will give WAG the right to reclaim the Akita without my permission and without any refund of any adoption donation.
Signature		Date
Signature		Date
Official Use Only