First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Place of Employment:*

Names of Dog(s) Applying for:*

Are you willing to take the time to housebreak a dog, and do you understand that changing a dog's environment may cause the dog to have accidents?*

If a behavioral problem arises, what steps will you take to work on it?*

If you are applying for a puppy/dog who is not house trained, how will you house train the dog?*

Veterinarian's Name and Phone Number*

Describe the kinds of personal situations where you might have to return your adopted dog, i.e., job loss, children, move, marital change, etc.*

For whom are you adopting the dog?

How many people live in your home?*

Any Children?*
Choose one: Yes No

If so, what ages?*

Who will be responsible for feeding and taking the dog outside?*

Who will take care of the dog in the absence of the primary caretaker?*

Will you be willing to obtain an appropriately sized, open-wire crate, if recommended?*
Choose one: Yes No

What kinds of animals have you owned?*

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No

Is your yard fenced?*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

How often will you exercise the dog, and for how long?*

How much time will the animal spend alone during the day*

When you are home, where will the dog be kept?*

Where will the dog sleep?*

When no one is home (i.e., at work, shopping), where will the dog stay?*

How often do you travel?*

What will you do with the dog when you travel?*

If you move, what will you do with the dog?*

Are you aware of the adoption fee ($75 non-refundable donation)?*
Choose one: Yes No

Have all adult family members met with and agreed upon the dog?*

Please list the animals you currently own, answering the following questions about each: Name, type of animal, age, sex, Is the Pet Spayed or Neutered?, Primarily indoor or outdoor?, how long have you had the animal?*

Describe all pets you previously owned in the past 5 yrs, answering the following about each: Name, type, spayed or neutered?, how long did the animal live, cause of death.*

I certify that the information entered on this applicant is true. Enter your name and date*

We will respond to your application via email as soon as possible. Please keep an eye on your Inbox for our reply!