Today's Date: Applying to: Name of dog, if known:
Check preferences for dog:
Select preferred characteristics :
My new dog must be able to get along with:
Are you willing to take the time to housetrain a dog?
Do you understand that changing a dog's environment may cause the dog to have accidents?
If a behavior problem arises, what steps will you take to work on it?
Will you take obedience training if needed?
Does a member of your household have an allergy to animals?
If yes,
explain:
Who are you adopting the dog for?
How many people live in your home? *
If children present, list: Number of boys: Ages:
Number of girls: Ages:
Who will be responsible for feeding and taking dog outside?
What kind of pets have you owned?
When you are home where will dog be kept? *
Where will pet sleep? *
How many hours will the pet be left unattended (e.g. workday)? *
When no one is home, where will dog be kept? *
How often do you travel?
What will you do with pet when you travel?
If you move, what will you do with the dog? *
Have you, or your spouse, been in the military?
Have ALL ADULT family members agreed upon adopting the pet? *
Has anyone in your family, or residing in your home, surrendered/relinquished a pet to an animal shelter or humane society? *
Has any person residing in the home where the pet is to live ever been accused of, or convicted of, a crime involving cruelty to, or neglect of, an animal? *
Have you ever had an application denied for adoption of an animal from an animal welfare group/animal control facility? *
Do you currently have an application pending for a pet with another organization? *
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C-1) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered?
Primarily indoor or outdoor?
When & how did you get the pet?
C-2) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered?
Primarily indoor or outdoor?
When & how did you get the pet?
C-3) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
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PREVIOUS PETS
(Pets you no longer have, but owned in the last six years) # of Previous Pets: *
P-1) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
Year you last had pet?
Why you no longer have pet:
Cause of death or where pet is now:
P-2) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
Year you last had pet?
Why you no longer have pet?
Cause of death or where pet is now:
P-3) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
Year you last had pet?
Why you no longer have pet?
Cause of death or where pet is now:
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List vets/animal clinics where your pets received care during the last 6 years: *
V-1) Name of vet or clinic:
Phone Number:
Owner name(s) records are listed under:
V-2) Name of vet or clinic:
Phone Number:
Owner name(s) records are listed under:
V-3) Name of vet or clinic:
Phone Number:
Owner name(s) records are listed under:
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Name of veterinarian to be used for this pet:
What type of home do you live in? *
Do you own or rent your residence? *
If you rent, Landlord name: Landlord Phone #:
What type of pets are allowed? Maximum Size:
If you have rented current residence for less than a year, provide prior address & landlord phone number:
Previous address:
Landlord's name: Landlord phone #:
Do you have a fenced yard? * If yes, what type of fence?
How tall? (Give range of heights, if applicable): Any holes or gaps?
Does the fence belong to you or neighbors?
Do you want the dog to be: *
How often will you exercise the dog? -for how long?