First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Please enter up to three dogs in the order of preference*

Do you own or rent?*

Does your landlord know you are looking for a new pet?*

Do you have a yard?*

How tall is the fence in your yard where the dog will walk (list the lowest section first)*

On a regular day, how many hours will the dog be left alone?*

Describe any experience you have had with obedience training, or with medical or behavioral issues*

List the members of your household. Name/Relation/Age*

Are all the members of your household in agreement about adopting a dog?*

Your age*

Your occupation*

Have you ever had to give up a pet? If so, why and where did the pet go?*

List and describe the pets you currently own*

Describe the dogs you owned before*

Please list at least one personal reference (Include name and phone number)*

Have you been involved in domestic disturbances in which the police were called? If so, explain.*

Please provide the name and phone number for your most recent or current veterinarian*

If you currently have pets, are they spayed or neutered?*

Are your pets up to date on their vaccinations and monthly preventatives?*

If you are adopting with a partner, who will get custody if there is a break up?*

Do you have a contingency plan to pay for unexpected emergency vet bills?*

Who will be responsible for walking the dog, how often & what times of day?*

How did you hear about us?*

Why do you want to adopt a dog?*