PTSD Adoption Application

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Home - Forms - PTSD Adoption Application

General Information:
First Name: *
Last Name: *
Email Address: *
Phone Number: *
Age: *
Street Address: *
City: *
State: *
Zip: *
Landlord Info. (for Renters)
If renting, please provide the Name and Phone Number of your landlord or management company.
Landlord Name
Landlord Phone
Military Status:
Rank: *
Branch: *
Status: *
Active
Inactive
If active duty, and your deploy, who will care for your companion animal?
Medical:<.strong>
Doctor, Case Manager, Supervisor’s Name? (If not applicable, put N/A):
Doctor, Case Manager, Supervisor’s Phone? (If not applicable, put N/A):
Medical Diagnosis:
  Post-Traumatic Stress Disorder
  Traumatic Brain Injury
  Depression
  Anxiety
  Other
  N/A
If other, Please Specify:
Are you able to complete your personal care needs? (Cooking, cleaning, bathing, etc.):
Yes
No
Pet information:
What kind of companion animal are you interested in adopting? *
What animals do you currently own? Please list kind and age of animal(s): *
What animals have you owned in the past? If not applicable, put N/A: *
Where are your previous animals now? If not applicable, put N/A: *
Have you ever been accused of or had an animal removed from your home because of abuse or neglect? *
Yes
No
Are there behaviors that concern you about your new companion animal? *
Yes
No
If Yes, please be specific:

After G. I. Wishes has paid for one (1) year of your Companion Animal’s health care, are you able to afford an estimated $70/month (animal health and food) for your Companion Animal? *

Yes
No

Are you capable of caring for a companion animal? (Walking/exercising, feedings, training, grooming)? *
Yes
No
Additional Information:
Who is your primary source of support?
Please list those who reside with you (if children please list ages). If not applicable, put N/A:
How many hours do you work per day? *
What is the best way to contact you? *
What is the best time of day to contact you? *
Required Documents:
Please supply one of the following documents/identification proving your status (Active Duty, Retired, Veteran).
*DD Form 214
*Retired ID card
*Active Duty card
If you do not have a copy of your DD Form 214, you may request a copy from the
National Veterans’ Service Records.

I understand that my G. I. Wishes maintains the authority to determine
which animal I am best suited to adopt due to predetermined traits and
behavioral tendencies of the animal. Any misleading or untrue statements
on this application will result in immediate denial of any G. I. Wishes
services. By my signature on this form, I verify that the above information
is accurate and true. I give my consent for G. I. Wishes to share my personal
information with their staff and supporters.

Do you understand the aforementioned statement? *
Yes
No
Do you understand that dogs adopted through G. I. Wishes are not certified as service or therapy animals? They are for companionship purposes: *
Yes
No
Full Name:
Date:
Please List 3 Personal References:
Name:
Phone:
Name:
Phone:
Name:
Phone: