Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Cell
*
(###)
###
####
Why do you want to adopt a dog? Please be specific.
*
How did you find out about the dog?
*
Your employer + job title
*
Name + phone number of your emergency contact
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Who will take care of this dog if you become unable to care for them? Please list their name, phone number and relationship to you.
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Do you rent or own your home?
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Rent
Own
If you rent, list the name + number of your landlord or name + number for your apartment complex
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If you rent, are there pet restrictions and if so, what are they?
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How many adults live in your home?
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How many children live in your home and what are their ages?
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If there are children, have they been around dogs?
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Yes
No
Somewhat
No kids in the home
Are all family members aware that you are considering adopting a dog?
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Yes
No
Describe your yard and its fencing
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If you don't have a big yard, how do you plan to exercise your dog?
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Do you have a pool?
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Yes
No
Does your pool have a fence around it?
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Yes
No
There is no pool
Do you have a doggie door?
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Yes
No
Tell us about all other pets in the home. List their species/breed, age, and any health or behavioral issues.
*
If you have other pets, please tell us the name of the veterinary clinic you take them to:
*
Are your pets fixed?
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Are your pets current on shots?
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Have you had any pets in the last 5 years that are no longer with you? If so, what happened to them?
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Have you ever returned or given an animal to another rescue, shelter, or animal control facility? If yes, please explain.
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Have you ever had a dog or puppy become sick from parvovirus? If so, how long ago?
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How many hours a day will your newly adopted dog be alone?
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Will you crate your newly adopted dog?
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Yes
No
Where will your newly adopted dog be kept when you aren't home?
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Where will your dog spend most of its time?
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Where will your dog sleep at night?
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The dog you are adopting will need to be provided with structure and you will need to follow through with their training. Are you willing to follow our recommendations for at least 90 days?
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What would this dog have to do for you to consider returning him/her to us?
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I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions can result in this application being declined. By checking the box below, I agree to the above statements.
*
