This is an application form for the adoption of Nyoka

Serious inquiries only.

Please include the following information and submit it by clicking on the submit button below.

This information is required in order to insure she finds a home that is good for her as well as her new humans. Please be patient and provide as much information as possible. If a question does not apply to you such as spouse information, leave it blank. Veterinarian and refernces are required.


General Information

First Name

Last Name

Address

Town

State

Zip

 

 

Spouse First Name

Spouse Last Name

Live together?

Children

List Ages of Children

Email

Phone No.

Yes No

Own your Home? Yes No
Do you have a Kennel?
Yes No
What type of environment? City Suburban Country
Have other dogs? Yes No
Have Cats?
Yes No
Please provide your employer information
Employer Name
Employer Address
City
Zip
Employer Phone
Email
How long at Current Employer?
Please list your spouse's employer information
Employer Name
Employer Address
City
Zip
Employer Phone
Email
How long at Current Employer?
Other Animals
Please list dogs you have now including spouse's
Breed
 Age
1. Name
2. Name
3. Name
How you will care for the Dog
Does your home have a yard?
Is there a fence?
What type of fence and how tall?

Is the fence secured underground as well?
If no fence, please indicate how you will exercise your dog
(choose as many as apply):
Invisible fence Cable runners Outdoor kennel Leash walk
Is someone home during the day?
Where will your dog be kept most of the time?
In the house Outside Basement Other: (specify)
If kept outside, will you have a dog house? Yes No
Do you keep your dogs inside or out at night? Inside Out

Where will you keep the dog when you are at work or out? Please explain in the text area below.
Do you have experience with large dogs? Yes No
Will you take your dog out into the community, walking, baseball, camping, bike riding, car rides... Yes No
Will you register your dog in the town or city in which you live? Yes No
Past Dogs
Please list name and type of dogs you've had in the past and where they are now.
Name Breed How Long did you have the dog?
Name Breed How Long did you have the dog?
Name Breed How Long did you have the dog?

Please list your veterinarian address and phone number for reference.

Name of Veterinarian

Veterinarian Street Address
City
Zip Code
Veterinarian Phon Number
Vet email
References
Please list three references.
Name Phone Number Email (optional)
Will you agree to return this dog to the original owner should you decided that you cannot keep it or that you are unable to properly provide for it by signing a letter of acknowledgement? Yes No

Click here to clear the form if you need to start over

Click here to submit the form

 

Back to Nyoka

Questions? Email Marina at marinap@quik.com or call 508-866-8173