First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Name and ID# of Dog(s) you are interested in:*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

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

Landlord's Name, Phone/Email (N/A if not renting)*

How many hours a day on average will your dog be left alone?*

Where will the dog be kept when you are not home?*

Where will the dog sleep?*

Will this pet live...*
Choose one: Indoors Only (except to play or potty outside) Predominantly Outdoors Combination

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

How often do you plan on walking your pet?*
Choose one: Never Rarely Once a week 3-5 times/week Daily Multiple times per day

How many people reside in your household? Please list all ages.*

What traits are you looking for in a pet? Please copy and paste all that apply: Independence, Dependence, Lap dog, Kid friendly, Energetic, Lazy, Playful, Serious, Sidekick, Cuddler*

Which characteristics would you not tolerate in a pet? Please copy and paste all that apply: Not housebroken right away, dog aggressive, cat aggressive, too hyper, digger, fence jumper, barker, drooler, protective over food/toys, not housebroken after training, none *

What is the best way to correct your pet's mistakes?*
Choose one: Swat on the butt Yell 'No!' Redirect the behavior Ignore, but praise when he/she does something good Kennel when he/she is bad Other

Do you have any other pets? If so, please list breed, age, and if they are UTD on shots and neutered/spayed.*

Have you owned any pets in the past 5 years that are no longer in your possession? Is so, please explain why they are no longer with your family.*

Veterinarian's Name and Phone Number: (If you do not have a vet, please list the vet you plan to use.)*

Under what circumstances would you return an animal to our rescue? Please copy and paste all that apply: Moving across state/into apartment, Lost job/can no longer afford, behavioral issues (i.e. dog aggression, etc.), health issues (i.e. hip displasia), having kids, gets too big, allergies, under no circumstance, other*

Is there any other information you would like to provide us with?

How did you find us?*
Choose one: Facebook SHH's Website Referral from Person Referral from Company SHH Event Booth Adoption Event Twitter Other

Are you over 18 years old?*
Choose one: Yes No

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