First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Which animal are you interested in* Sorry, no animals found
Explain your interest in this dog
Explain your interest in this breed
Do you have a vet?*
Veterinarian's Name
Vet Address
Vet City
Vet Phone
Length of Relationship
In what type of home do you live* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing
Is your yard fenced* Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced
What type of fence Choose one: Privacy Chain Link Invisible
What is the height of the fence
Do you own or rent your home* Choose one: Rent Own Other
If you rent, please enter your landlord's name and phone number or name and number of property management company
If you rent, have you checked your lease requirements for pet policies? Are pitbull or pitbull mix type dogs OK to live on your property per your lease Choose one: Yes No
Who is your home owners or renters insurance provider*
How many people reside in your household*
How many children are in the house*
If children are present, what are their ages?
If other adults are present, please provide their names and relation to you
Please list all animals currently living in your home
Are all of your animals spayed/neutered
Are all your animals up to date on vaccinations
Please list your past animals and why they are not with you any more.*
Will the animal be kept inside or outside* Choose one: Inside Only Outside Only Inside and Outside
Where will the animal sleep*
Where will the animal be kept when you are not home*
Where will the animal be kept when you are home*
Who in the household will care for the pet*
Describe how you will train the pet*
What issues are you willing to work with*
What issues are you not willing to work with*
Reference #1*
Reference #1 Phone*
Reference #1 Email
Reference #1 Relation to you:*
Reference #2*
Reference #2 Phone*
Reference #2 Email
Reference #2 Relation to you*
Reference #3*
Reference #3 Phone*
Reference #3 Email
Reference #3 Relation to you*
Why are you interested in adopting a pet at this time*
How did you hear about us*
What are your thoughts on Spay/Neuter*
Are you applying with other rescues?
Do you have any comments or questions
I have read the Adoption Process, Policies and FAQ on the website
I am at least 18 years of age
I certify that the information entered on this applicant is true. Enter your name and date*