| Name of Applicant*: | |
| Address*: | |
| City*: | |
| State*: | |
| Zip code*: | |
| How long have you lived at this address?*: | |
| Phone*: | |
| E-mail Address*: | |
| Which dog are you interested in adopting?: | |
| Do you have a fenced in yard? If so, please describe the height and type of fence and size of yard.: | |
| If no fenced yard, what provisions are there to protect and control your dog during exercise and potty breaks?:: | |
| Will this be your first pet?: |
|
| What kind of pets do you currently have in your home? Please include breeds, ages. : | |
| Are your pets spayed and neutered?: |
|
| Are your pets up to date on their shots?: |
|
| Where did you get your pets?: | |
| Name and Phone number of current veterinarian. *: | |
| Do you have children?: |
|
| If yes, please list ages of children.: | |
| How many adults in the home? Please list names and ages. Are all members in favor of adopting a pet?: | |
| Who will be the primary caregiver for this pet?:: | |
| List your last 3 pets and the reason they are no longer with you.:: | |
| Why have you chosen to adopt a pet? (check all that apply): |
|
| What characteristics do you desire in a pet?: |
|
| How long each day will your pet be left alone?: | |
| Please describe any experience you have with obedience training or other training. : | |
| Where will the pet be kept when you are not at home during the day? At night? When you are out of town?*: | |
| Are you adopting for yourself or for someone else?*: | |
| Describe in detail the kind of dog you are looking for:: | |
| Have you ever turned an animal into a shelter? Yes or No. If Yes, please explain.: | |
| Does any member of your family have allergies to dogs?: | |
| Do you own or rent?: |
|
| If you rent, may we contact your landlord? Please provide contact information.: | |
| Your occupation: | |
| Name and phone number of employer. How long have you been employed there?: | |
| If your new puppy isn’t housebroken, What method will you use to train him/her?: | |
| Do you have a dog door ?: |
|
| How much daily exercise will your dog receive?: | |
| If you drive a pick up, would you allow the dog to ride in the bed of truck?: |
|
| What arrangements will you make for your pets in case of an emergency?: | |
| If you move, Will you take the Dog with you? Yes or No. If No, please explain.: | |
| Are you willing to care for and be responsible for the dog for the next 10 to 15 years?: |
|
| What provisions will you make for the dog should you become unable to care for him/her?: | |
| How much are you willing to spend on medical bills for your dog?: |
|
| What would you do if the medical bills went over this ammount?: | |
| Please provide two personal references. Include Name, Address, Phone Number, and Relationship: | |
|
