Why do you want this particular dog?__________________________________

What will you do with your dog if you move or go on vacation?_________

How much do you expect to spend on your new dog in a year?____________

What will you do if your new pet chews things, dumps trash, etc.?

______________________________________________________________________

Please check all of the following that will apply to your new dog:
   Watch Dog:____       Companion:____    Hunting Dog:____  
   Guard Dog:____      Family Pet:____          Other:____

Will your dog ever be transported in the back of an open pickup?______

If your dog sleeps on the bed and takes up most of the bed, do you ...
  (A) Make him get off the bed?
  (B) Go sleep somewhere else yourself?

OTHER PET INFORMATION:

Do you have other pets? Type and Number:______________________________

If your other pets are cats and/or dogs, are they spayed and/or 

  neutered?____  If no, why not?______________________________________

Are your other pets current on their vaccinations?____________________

  Veterinarians name:_________________________  Phone:________________

What will you do if your newly adopted pet does not get along with 

  your other pets for a while?________________________________________

Do any of your pets have an infectious disease now, or have they in

  the recent past? ____

I certify that the information provided on this form is true and
correct.  I am also financially able to care for this animal.  I 
understand that proper food and veterinary care will be costly and am
able to meet these requirements.  I understand that in some cases, a
home check may be mandatory prior to your adoption.  I understand that
any false statements constitute grounds for confiscation and surrender
of the animal to the Bitter Root Humane Association. I further 
understand and agree that the Bitter Root Humane Association may   
demand return of the animal for any violation of the terms of the 
adoption contract and agreement.

Signature:____________________________________  Date:_________________

                  BITTER ROOT HUMANE ASSOCIATION
             RESERVES THE RIGHT TO REFUSE ANY ADOPTION.

FOR STAFF ONLY:

Approved:____  Refused:____  Comments:________________________________