ECGRR – Application For Adoption – page 4 of 4

IMPORTANT: ALL FOUR (4) PAGES MUST BE COMPLETED FOR YOUR APPLICATION TO BE CONSIDERED
Incomplete/partially completed applications are purged from our system after 24 hours.

This is the last page of the Adoption Application. Once you submit it a confirmation page will be displayed.

Heartworm preventative	What type will be used? If unknown then type "unknown". Heartworm disease is serious and potentially fatal to pets. We require all adopted dogs to be tested annually and be on a regular preventative.
Vet name - address	Please list the name, address and phone number of your current vet. If you do not have one, please indicate a veterinary service you will most likely use.
How long will dog be alone	How long will dog be alone Almost None About 4 hours daily About 8 hours daily Varies daily other: Select the best choice.
Where will dog stay at your home?	Where will dog stay at your home? Outdoors Indoors other:
If required to move - what about the dog?	If required to move - what about the dog? With Us Give to a family member Give to a friend Give to a local shelter No plans to move other:
Past Surrenders	Past Surrenders Yes No Have you ever surrendered any past pets to a shelter or rescue organization?
Understand regulations	Understand regulations Yes No Do you understand your local laws and regulations for pets?
Adopt before meeting dog.	Adopt before meeting dog. Yes No Would you adopt a dog without meeting it first?
Signature applicant	Full typed name
Signature co-applicant	Full typed name of co-applicant