Name of dog or dogs you are applying for.
Name of ALL adults 21 years and older residing in the home, include spouses, relatives, roommates, partners, etc.
Please provide ages of all people residing in the home including children.
Street address, city, state and zip code (no P.O. Boxes)
Phone numbers where you can be reached.
Do you own your own home?
Please select type of residence you own.
Single family home
Townhome or condo
Do you rent?
Please select type of residence you rent.
Single family home
Townhouse or condo
If you rent, please include full name and phone number for the landlord or leasing agent.
Which adult will be the primary caregiver of the dog?
Do you have a securely fenced yard on all sides that is escape proof for small dogs? Invisible fencing is not acceptable.
Please choose type of fencing.
Post and rail with chicken wire
Please list all current living pets by Name, Species, Breed, and Age, eg., Lassie, Canine, Collie, 6 years.
Please list all animals that you have had in the last five years that are no longer with you and the reason, eg., Felix, Feline, 15 yrs., euthanized due to age related illness.
Are all your pets spayed or neutered?
Do all your pets have a current rabies tag?
Do you do annual exams for heartworms and/or keep on preventative?
Do any of your pets live exclusively outside, if so, what is the reason?
Does anyone living in the home have any known allergies to dogs?
Please name all vets or clinics and numbers that would have records on your past and/or current pets.
Does anyone residing in the home smoke? If so, where are they permitted to smoke?
What hours would the dog be alone during the day without adult supervision?
Where will the dog be expected to stay when you are not at home? Please be specific.
Where will the dog spend the majority of it's time? Please be specific.
Please give two personal references with names and numbers. One must be a neighbor.
Please choose a lifestyle option that would best describe what you expect of the dog.
Active: Jogging, running, playing fetch.
Medium: Walking, playing with toys, velcro dog
Sedentary: calm, senior, couch potatoe, snuggler.
Have you ever adopted from a rescue or shelter?
Have you ever surrendered an animal to a shelter or rescue? If so, please describe reason
How quickly will you be ready to adopt?