Full Name (First and Last Name): *
Co-Applicant Full Name:
Full Address (Street, City, State, Zip): *
Mailing Address (if different):
Names and ages of everyone in the household: *
Home Phone:
Cell Phone: *
Work Phone: *
Email *
Complete the answers to the following will help us match your specific needs and expectations: Age Desired (Any, specific age, senior 8 years or older): *
Is there a specific dog you are interested in? If so, which one? (Specify name, color & gender) *
Why are you interested in this particular dog? *
Choose Activity Level * choose one High Medium Calm Any
Who will care for, train and exercise the dog? *
Does anyone in your household have allergies? If yes, to what allergies? *
Please list all of the most recent pets that you have owned in the past. Species dog/cat: *
Sex of Pet(s)? *
Were they spayed or neutered? *
Provide name of current veterinarian: *
Phone number for current veterinarian: *
City, State and Zip for current veterinarian: *
Where do you purchase heartworm prevention if not from your veterinarian? *
Brand of heartworm prevention: *
Please identify any other veterinarians that you have used most recently (Include Name, Phone, Address): *
How long have you lived at your current address? *
RENTERS: Landlord's Name and Phone:
Do you have the permission of your landlord to have a dog? If so, up to what size?
Will the dog be allowed in the house?
How long daily will the dog be left alone (without humans): *
Where will the dog stay when you are away from the house:
Type of fence? (Height, Width & Length)
If you do not have a fence, will you install one? *
Approximate size of dog(s) yard area: *
Have you ever sold, given away, or surrendered a pet to a shelter? If yes, please specify why: *
Please tell us a little of your lifestyle, your family including any special activities in which your dog would be included. (If you have any requirements or requests for a dog, please let us know so that we can more carefully match a dog to your lifestyle): *
When you move, what will you do with your dog? *
Have you, or any member of your family or household ever been cited for leash law violations or cruelty to animals in the past? If yes, please specify? *
When you go on vacation who and where will it be cared for? *
I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge, I/We understand that submission of this application does not guarantee adoption of a dog. *
Submission by email will serve as signature agreement / Enter Today's Date: *
Co-Applicant Signature
Comments/Questions?
