Epic Blue Acres Adoption Application :
Please cut and past to email or print, complete then fax back to us @ 716-791-3367


Name:__________________________________________________________________

Address:_______________________________________________________________

       _______________________________________________________________


Home: (________ )__________________

Cell: (________)____________________

Work: (________)____________________

Email: _____________________________________________

Drivers Lic # : __________________________ State: ________

SS# :________________________ *complete for check cashing purposes only*

How did you hear of us: _________________________________

Do you? rent ______ own______ other_________
Single Family home, Duplex, Town House or Apartment? ________________
If renting: Landlord info__________________________________
___________________________________________________________

Are there children in the household? Yes_______ No ______
If yes-Ages: __________________________________________
_______________________________________________________

Do you have other pets in the household? Yes_____ No_______
If YES- What kind / breed,age,sex: _________________________ _______________________________________________________
____________________________________________________

Name of Veterinarian:___________________________________
Phone:(_______)_____________
*Please contact your vet upon submission of this form to ok release of info to Epic Blue Acres*

Personal reference: ___________________________ phone:(_____)_______________ relationship:______________________ How long have you know them?__________________

Have you ever owned the breed you are looking to adopt? Yes____ No_____
If so what happened to it? ______________________________

Do you have a fenced yard?_______ How high? ____________
What material is your fence?______________________________
If no fenced yard how will you exercise/let the dog outdoors? ________________________________________________________

How many hours a day will the dog be left alone? ________________________________________________________
Were will the dog be kept when left alone? ________________________________________________________

Dog you wish to adopt:__________________________________
Why?________________________________________________ ________________________________________________________ ________________________________________________________

What characteristics are you most looking for in your new dog? (ie: active,submissive,laid back,etc...) __________________________ ________________________________________________________ ________________________________________________________
Tell us anything more about your family, your home, people in your household, your neighborhood... ________________________________________________________ ________________________________________________________

By submitting this application you understand that if this adoption doesn't work out, you must return the pet to Epic Blue Acres and there will be no refunds given.You fully understand the previous questions and you have answered them honestly. If you do not understand, please ask for clarification.

Applications are not based on 1st come 1st served.Approved applications are based on the best home for that particular pet and/or the best pet for your household/lifestyle.

We do reserve the right to refuse adoption for any reason