Which animal(s) are you interested in adopting? (required)
Your Name (required)
Street Address (required)
City (required)
State (required)
Zipcode (required)
Your Phone (required)
Your Email (required)
Do you have children under 5? (required)
YesNo
Do you live in: (required)
HouseApartmentCondoTown House
Do you: (required)
OwnRent
If you rent, do you have your landlord's permission to have a dog?
Landlord's Name
Landlord's Phone
How much of the time will the dog be outdoors? (required)
How much of the time will the dog be indoors? (required)
About what percent of the time will the dog be left alone? (required)
Where will the dog be left alone? (required)
What area(s) of the house will the dog be allowed into? (required)
Where will the dog sleep at night? (required)
Do you have a fenced yard? (required)
If so, how high is the fence?
Type of fence?
Are the gate(s) normally locked?
Do you have a pool? (required)
If so, is it fenced separately from the yard?
Why do you want a dog? (Check all that apply) (required)
House petCompanion for other petProtection for home/familyCompanion for familyCompanion for childrenProtection for businessAs a gift
Do you have other pets? (required)
If so, how many?
Dogs: Cats:
Other pets?
If you have any dogs or cats, are they spayed/neutered?
What pets have you had in the past?
What happened to the ones you no longer have?
What would happen to the dog if you moved?
Do you have a regular veterinarian? (required)
If so, vet’s name
Name of clinic
Clinic's address
Phone
Does anyone in your household have allergies? (required)
If so, what kind?
How would you train this dog? (Check all that apply) (required)
Obedience schoolFirm verbal commandsHit with newspaperClicker/hand signals
Other (Please Specify)
Will you be able to live with hair on your furniture, strains on your rugs, or and animal that maybe destructive at times? (required)
Remember, pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, proper shelter and exercise for your new pet? (required)
Are you able to make a long term commitment to care for your pet for its entire life span, which could be as much as 10-20 years? (required)
Are you willing to let a representative of the rescue visit your home by appointment? (required)
Under what circumstances would you not be able to keep this dog? (required)
Please list someone who is familiar with both you and your pets (required)
Name
Address
Relationship
Please list someone else who is familiar with both you and your pets (required)
Is there anything else you would like for us to know?
