Adoption application - Dirks Fund Dog Shelter

526 Indian Warpath Drive

Pacific, MO. 63069 (Directly across from Pacific HS.)

Sat & Sun 10AM-2PM

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Adoption Application

Name

Email

Phone

Address

City

State

Zip

Why do you want a dog?

Companion Outside dog Gift Other

Where will your dog sleep?

In crate With Owner Outside In Basement Other

How long will the dog be left alone during the day?

0-2 hours 2-4 hours 4-6 hours 6-8 hours 8-10hours 10+ hours

How are you containing the dog outside?

Tie out Leash Permanent Fence Underground Fence Acreage Free Run

If you have a fenced yard, what type of fence?

Vinyl Chain Link Wood Aluminum Other

How tall is your fence?

3ft 4ft 5ft 6ft+

Have you had other pets?

Yes No

What happened?

Gave Away Died Lost Still Have

If you still have pets, what kind?

Dog(s) Cat(s) Bird(s) Other(s)

Who is your current (or previous) veterinarian?

If you have children at home, what are their ages?

Which of our current dogs are you interested in?

Message

You should receive an email response within 24 hours.

critters@dirksfund.com
526 Indian Warpath Drive Pacific, MO 63069 (Directly across from Pacific HS.)

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