Form DD 3076-7 DD 3076-7 Department of Defense Military Working Dog Adoption Appl

MILITARY WORKING DOG ADOPTION APPLICATION

OMB no. 0701-MWDA
Expiration: XXXXXXXX

Privacy Act Statement
The Following information is provided to comply with Privacy Act (PL93-579). 5 U.S.C. 301 authorizes the acceptance of this information requested on this form. The data will be used to
contact applicants and to interview, screen and select them for volunteer adoption. Furnishing this data is voluntary.
The public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dodinformationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.

Date:

Name (Last, First, MI):

Address (Unit, Street, City, State):

Zip:

Email:

Primary Phone:

Secondary Phone:

Applicant Information

Applicant Spouse Information

Age:

Occupation:

Place of Employment:

Age:

NEEDS DD67
Occupation:

Place of Employment:

Ages of Children in Household:

Ages of Adults in Household other
than Adopter and Spouse:
What type of of dog are you interested in adopting? (sex, breed, age and name)

Describe your ideal dog:

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MILITARY WORKING DOG ADOPTION APPLICATION (Continued)

How many other pets do you currently own or have living in your home?
Name of Pet

Type/Breed

Maximum number of hours the dog will stay alone?

Age

Gender

Spayed/Neutered

Where will the dog stay when no one is home?

Where will the dog stay during the day?

At night?

NEEDS DD67

Where will the dog stay when the family is out of town?

Will the dog be left outside unattended at any time? If yes, please explain:

Describe the area where you live (city, suburban, rural, yard size, etc):

Do you own your home or rent? (select one)

If you rent, do you have written permission from the property owner to adopt a pet? (yes or no)

Do you have a fenced yard? (yes or no)

How high is the lowest part of the
fence? (Feet)

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Type of fending material? (Wood,
Chain, etc)

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MILITARY WORKING DOG ADOPTION APPLICATION (Continued)
If the dog you adopt is not yet housebroken, what method of house training do you plan to use?

As part of our legal binding adoption agreement, your adopted dog MUST receive veterinarian care
Veterinarian Name:
Address
(Unit, Street, City, State, Zip):
Email:
If yes, what type?

Are your dogs on heartworm preventative? (yes or no)

You agree to provide your adopted dog with monthly heartworm preventatives and yearly vaccinations? (yes or no)

You agree to provide appropriate medical care and yearly checkups for your dog? (yes or no)

NEEDS DD67

Reference 1 Name:

Address
(Unit, Street, City, State, Zip):
Email:

Phone:

Reference 2 Name:
Address
(Unit, Street, City, State, Zip):
Email:

Phone:
How did you hear about the Military Working Dog Adoption Program?

DD FORM 3076-7, 20200709 DRAFT

PREVIOUS EDITION IS OBSOLETE.

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