Please enter ID type and number. ie: MI driver license*
Are you over 18 years of age?*
Check Box if Retired
Are you a member of any branch of the U.S. military (active, reserve or veteran)?
Who else is in the household?
# of adults*
# of children*
Please list age(s) of children
If you selected Rent or Living W/Family or Friends in the question above, Please provide the information requested in the next 2 items.
Name of Landlord/Homeowner
Landlord Phone Number
Application is for:
Which of our animals are you interested in?
Choose an animal:
Kitten - female
Kitten - Male
Kitten - Male
if you are interested in more than just the above animal, please list them below
Would you be willing to consider a dog/cat of a different age or sex?
If so, Please select as many choices that you like
Do you have a fenced yard?
Do you have a dog run?
Describe fence/yard (type, height & approximate size):
If no fenced yard or dog run, how will you handle your dog's exercise and toilet needs?
Who will be responsible for the care of the animal?
How many hours per day will the dog be left alone?
0 - 2 hrs
2 - 4 hrs
4 - 6 hrs
6 - 8 hrs
8 + hrs
Have you ever owned a pet before?
Please list other pets currently in the household, including name, breed, age, sex, whether or not spayed/neutered and how long you have owned the bet
My pet will be kept in:*
If outdoors, please select one
Outdoor dog run w/insulated dog house
Fenced yard w/insulated dog house
Tie-out w/access to insulated dog house
Do you have a veterinarian?*
Name of veterinarian
Phone number of veterinarian
Name and age of pets taken there:
How will you address behavioral issues (ie: chewing, digging, scratching, house training or escaping)?
Please provide 2 personal references.
Reference #1 Name*
Reference #1 Phone number*
Reference #2 Name*
Reference #2 Phone number*
1. I certify that all statements on this adoption application are made truthfully and without evasion, and further understand that such statements may be investigated and if found to be false will be sufficient reason for not being allowed to adopt/foster from Koby's Promise.*
2. I authorize Koby's Promise to contact any reference(s), my veterinarian(s) and anyone else deemed necessary to confirm how I have cared for my companion animals*
3. I authorize my veterinarian(s) to release to Koby's Promise all veterinary records of the animals i own or have owned.*
By typing my name in the box below, I hereby submit this application and authorize Koby's Promise to process it.*