Epic Blue Acres On Line

Non Binding Adoption Application

Name of dog(s) you wish to adopt:

I am looking to adopt:

Adoptors Name:

Address:

City:                                                  State:

Home phone #:

Zip:

Cell phone #:

On Line Application is still under construction. Please just copy and paste printable application to email

Work phone #:

Email:

Drivers License # and State:

SS#:

(for check cashing purposes - can leave blank til time of adoption)

How did you hear of our rescue:

Do you ?

Type of home:

If Renting please provide landlord contact info:

If you chose "other" in the above, please specify:

Are there children in the home?

If YES - ages:

Are there pets in the household?

If YES - please fill out the below "Pets"

Pet 1:

Breed:

Sex:

Altered :

Age:

How long have you owned:

Pet 2:

Breed:

Sex:

Altered:

Age:

How long have you owned:

NowKeep application on file for future dogs

RentOwnOther

Single FamilyDuplexTown HouseApartmentMobile homeOther

YesNo

YesNo

YesNo

YesNo