| What is the First and Last Day of the animal you are interested in: |
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| What is the letter and number of the dog you are interested in : |
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| First and Last Name : |
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| Phone Number: |
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| Email: |
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| Are all family members available to meet the animal you are interested in: |
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| Do you live on base? If so what base: |
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| Do you live off base? If so what area: |
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| How many hours a day will the animal be left alone: |
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| Do you have children?: |
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| If so please list the ages (please note we do not adopt to families with children under 2 years old - no exceptions): |
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| Are you expecting or planning on having children in the next two years?: |
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| Have all family members been around cats & dogs before and if so, are there any known allergies?: |
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| Do you currently own any animals: |
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| Please list the breed, age and sex of each animal you currently own: |
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| Are all of your animals fixed and up to date on shots? (We require proof that all current animals are fixed and up to date on shots): |
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| Have you owned an animal in the last 5 years that you do NOT currently have with you: |
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| If so please explain where that animal is now (rehomed, with family, shelter, deceased): |
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| When is your DEROS (PCS date): |
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| If you are single what is your plan for the animal if you deploy or go TDY: |
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| If you are married what is your plan for the animal if you divorce: |
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