Adoption Form

Name: *

Veterinarian's Address, City, State and Zip

Will this pet be a surprise for anyone? If Yes, who?

Are any family members of your house hold allergic to pets?

Yes

No

What are the maximum hours pet will be left alone on a typical day?

How many children are in the home and what are their ages?

Have you ever given up a pet? If Yes, Why?

Would you try to fix the problem? If Yes, How?

Co-Applicant

If you date or marry someone who does not like or want pets, what will you do?

Have pet put to sleep

Give pet to rescue group or shelter

I would end the relationship before giving up my pet

Other

Address, City, State, Zip *

Can you provide a permanent loving home for this dog for 10-15 years?

How many pets do you currently have in your home?

Are you aware of any issues that currently exist that may impact your ability to care for and / or keep a dog? If Yes, please explain:

Are there any other adults living in the household?

Yes

No

Do you:

Own

Rent

In addition to those listed above, what other pets have you owned? Please describe what happened to each of those pets:

Have you ever looked at or applied for a pet with another rescue group? If Yes, Please list.

If other, please specify:

Is your yard fenced in? If Yes, what type and what is the height?

Employer and Occupation

Phone *

Email: *

Check here to receive email updates

How many times have you moved in the last 5 years?

Veterinarian's Name and Phone number

Are you willing to keep a collar and ID tag on all of your pets including a new dog at all times? If No, Why not?

Does your landlord / lease allow pets?

Yes

No

Work Phone and email address:

Who will be responsible for daily care and training of your new dog?

Self

Spouse

Children

Roommates

Which dog are you interested in? *

Amount of pet deposit:

If Yes, what steps will you take to accommodate the dog(s) and the household member?

Please indicate where you live:

Apartment

Condo / Townhouse

House

Other

If your dog develops an expensive medical problem what would you do?

Have pet put to sleep

Give pet to rescue group or shelter

Spend whatever was needed to correct the issue

Other

Did you adopt?

Do your current or past pets receive heart worm or flea preventative? If yes, please list type and frequency. If no, why?

Name and phone of apartment complex or landlord:

If Yes, Please List Name, Relation and Age below:

Please list Type, Age, Spayed/Neutered and if they are current on vaccinations:

REFERENCES: Please list two references to include: Name, Address and Phone Number.

Is there a limit to the number of pets allowed?

Yes

No

Have you ever had a serious behavior problem with a previous dog? If Yes, Please explain.

If other, please explain

Will you ever let your dog off leash in an un-fenced area? If yes, please explain.

Is there a restriction on weight or breed?

Yes

No

What are you working hours?

Are you willing to allow a representative to visit your home by appointment? If No, why?

How much do you expect to spend annually on vet care for your dog?