First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone*

Cell Phone

Which dog/puppy are you interested in meeting? If none specific please write puppy or dog*

Would you prefer email or text contact?
Choose one: Email Text

Can the phone number listed accept text messages?

Spouse/Partner:

Select the number of adults in your household?*
Choose one: 1 2 3 4 5 6 7 8 9 10

Supply the first and last names of the adults in your household: (put n/a if you are the only person in the house)*

Select the number of children in your household?*
Choose one: N/A 1 2 3 4 5 6 7 8 9 10

What are their ages? If no children, indicate N/A.*

Employer/Source of Income:*

How long have you been with your current employer?*

Are you a student?*
Choose one: Yes No

If yes, what school do you attend and what is your year of study? If not applicable, type N/A:*

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

Do you: own, rent, live with parents?*
Choose one: Own Rent Live with Parents

If rent provide Apartment Complex & phone number or Landlord name & phone number. PLEASE be sure to include your apartment number. If not applicable, type N/A.*

If you live with your parents, provide their name and phone number. If not applicable, type N/A.*

If you have no pets currently, type N/A*

Please provide the name and phone number of the veterinarian who can provide medical history of current pets. If not applicable, type N/A.*

Have you had previous pets in the past five years that no longer live with you? *
Choose one: Yes No

If yes, answer the following for each pet: Name, Type (cat/dog/bird/reptile/other), Time Owned, Age at time no longer in home, What happened to this pet? If not applicable, type N/A.*

Previous Vet Name and Phone Number. If not applicable, type N/A.*

Who will be caring for your pet in 15 years? *

Where will your new pet spend its days and nights? Do you have a separate space away from any animals in the home during the introduction period (describe)?*

Expenses for a pet can average over $1,000 per year. Should a serious illness or accident happen, the cost can be two to three times that. Are you prepared for these expenses? *
Choose one: Yes No

Approximately how many hours out of 24 per day will the pet be alone?*

Are you ready to commit to ten to twenty years (depending on age) with your pet? *
Choose one: Yes No

Are you willing to contact a behaviorist if necessary? *
Choose one: Yes No Maybe

How many days are you willing to spend helping the new pet adjust to your home? *

If you become unable to care for your pet(s) (such as incapacitation or death), what is your plan for their future care? *

Does anyone in your home have any known allergies to animals? If yes, please describe:*

Does anyone in your home smoke? If yes, please describe:*

Have you purchased the supplies needed to bring home a new pet immediately?*
Choose one: Yes No

Has everyone in the household agreed to have a new pet in the home?*
Choose one: Yes No

Under what circumstances would you return the pet (ie moving, having baby)?*

What is the usual activity level in your home (ie busy, relaxed, loud, quiet)?*

What qualities/look/age are you looking for in your new pet?*

Personal references - Minimum one required.

Please provide the name, relationship to you, and phone number for your references*

Does your yard have a fence? *
Choose one: Yes No N/A

What Type of fence? How high? (Answer N/A if no fence is present)*

Does your lease/HOA restrict ownership of pets or specific breeds?*
Choose one: Yes No

Other Comments

All the information I have provided is true and complete to the best of my knowledge. Should a cat or dog be placed with me, it will reside in my home as a pet. I agree to provide humane care and maintenance such as food, water, shelter, affection and veterinary care through the rescue. I agree to allow Colony Cats & dogs to retain my information for their records.*
Choose one: I agree