Lee County Cell Dog Program Adoption Application
Name: ________________________________________ Date of Birth: _______________________
Address: __________________________________________ City: ___________________________
State: ___________________ Zip: ________________ Telephone: ____________________________
Cell Phone: _________________________ Length of Time at Current Address: _________________
Place of Employment: _____________________________ Occupation: _______________________
Work Address: __________________________________ Work Phone: ________________________
Length of Time at Current Employer: _______________________ Type of dog desired – sex, age,
color? ___________________________________________________________________________
Have you ever owned a dog before? Yes or No (circle) If no, how are you preparing for a new
dog: ________________________________ Does everyone in your family want a dog? Yes or No
Why have you chosen a Lee County Cell Dog? ____________________________________________
Are there children living in the home? Yes or No Age of Children: __________________________
How have you taught them to respect animals? ____________________________________________
Are there other pets in the household? Yes or No Are they neutered or spayed? Yes or No
Please tell us about your current pets (breed, age, sex): ______________________________________
__________________________________________________________________________________
If you have previously owned pets, please list them and their current whereabouts: _______________
Do you rent, or do you own your own home? Own or Rent If renting, does your landlord allow
pets? Yes or No Landlord name: ____________________________ Phone: _________________
If you move in the future and your new living arrangements does not allow pets, what will you do with
them? ___________________________________________________________________________
What will you do with your pets if your life circumstances change, i.e., divorce, separation, death in
the family, etc.? _____________________________________________________________________
Do you currently have a regular Veterinarian: Yes or No Please list your Veterinarian's name and
phone number: ______________________________________________________________________
As a reference, please list the name and phone number of one other person who knows how you relate
to animals: _________________________________________________________________________
Do we have your permission to contact your landlord, veterinarian and reference? Yes or No Are
you familiar with rules governing dog ownership in your community? Yes or No Do you have a
fenced yard? Yes or No If yes, please describe the enclosure:_____________________________
If no, how do you plan to exercise your dog? ______________________________________________
If you currently do not have one, are you willing to install a fence or dog run? Yes or No Will your
dog be left unattended outside for any period of time? Yes or No If yes, under what circumstances?
_________________________________________________ Will someone be at home during the
day? Yes or No Where will your dog be kept while you are not home? _____________________
____________________ Where will your dog be kept at night? ______________________________
Where will your dog stay if you're away overnight or away on vacation? _______________________
Who will be responsible for your dog's upkeep (training, grooming, feeding, vet visits, exercise)?
_______________________________________. Until your dog learns the rules of your home, he
may urinate in your home, and may chew household items. Please describe how you will discipline
your dog. _________________________________________________________________________
Please add any comments that may help us make a decision: __________________________________
A home visit may be required prior to adoption. Do you have any objection to a volunteer visiting
your home? Yes or No Are you prepared to make a lifetime commitment to this dog? Yes or No
ALL animals need some time to adjust to their new surroundings, especially when other animals are
involved. The cell dog trainers, inmate handlers, and of course, the dogs, have all worked very hard to
complete their training. Are you prepared to devote extra time to your new pet by continuing their
training at the Companion Training Center? Yes or No
Training classes are normally on Tuesday evenings at 6:30 p.m. Will you be able to attend
class with your new pet at this time? Yes or No
We assure the applicant that each of our dogs are evaluated by a
Veterinarian, receive vaccinations, are de-wormed, spayed or neutered, tested for
heartworms and put on heartworm preventive. It will be your responsibility to maintain yearly
vaccinations, as well as heartworm, and flea and tick preventative. We
reserve the right to refuse any application for any reason.
You may fax the application to (239) 477-1788