Name of dog you are interested in (if more than one, please select first choice and list any others in the comment box at the end of the form):
Choose an animal:
Bella Brown *LIVES WITH A CAT*
Cub *Live with CATS and DOGS*
Dexter **Courtesy Post**
Molly *super sweet*
Otis *Loves to play!*
Zoey *LIVED with CATS*
Primary Adopter Employer*
Primary Adopter's Work Phone
Driver's License Number (only if paying by check, can be provided at time of adoption)
DL Expiration Date
Secondary Adopter's First Name
Secondary Adopter's Last Name
Secondary Adopter Phone
Secondary Adopter's Email
Name of friend we can contact if your dog is found and you cannot be reached*
How many adults reside in your home?*
How many children reside in your home?*
What are the ages of the children?
If "Other", please explain
If "Rent", please provide the name of your rental office or landlord
If "Rent", please provide the phone number for your rental office or landlord
If "Live with parents", please provide a parent's name
If "Live with parents", please provide a parent's phone number
Type of housing*
Will this dog live inside the home?*
How will you contain this dog when it is outside?
How many hours a day will the dog be left alone?*
Please list dogs you've owned in the past five years, starting with current or most recent:
Dog Number 1
Up to date on shots?
What happened to this animal?
Dog Number 2
Dog Number 3
Name of your veterinarian*
If you have ever had to surrender a dog to a friend, shelter, or pound, please explain why*
What behaviors in a dog would you find unacceptable (such that you would want to return the dog)?*
If you don't have one of our specific dogs in mind, please describe the type of dog you are looking for
Additional comments, questions, or concerns
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