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91 Ready Ave N.W. Fort Walton Beach, FL 32548
    911 Ruff Hours of Operation: 10am - 7pm, 7 Days-a-week    
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ADOPTION APPLICATION FORM
 
Thank you for your interest in our dogs. We would appreciate your answers to the following question so we can best find the right canine for you. Submission of this application does not guarantee that you will receive a dog.
First Name:
  		Date:
 
Last Name:
 
Age:
  		E-Mail Address:
 
 
Address:
 
City:
 
State:
  		Zip Code:
 
Home Phone:
  		Cell Phone:
 
Are you married or have a significant other?


Spouse's Name:
  		Spouse's Age:

 












Are you self employed?



Employer:
  		Dept:

  		Phone:
 
Spouse's Employer:
  		Spouse's Dept:
  		Phone:
 





If military, what is your rank:  
Number of Children:
  		Their Ages:  
Is everyone in your household in agreement on adopting a canine?  
If no, who is not?   Why?
 
Besides yourself, who all resides in your home?  
Names & Ages:  
Do they have pets?  
Whose name is the lease / mortgage in?  
How long have you lived at your current address?  
If less than 2 years, please list your previous addresses including City and State for the last 10 years: