First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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County*

Email*

Home Phone

Work Phone*
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Cell Phone*

Alt Email

Which animal are you interested in?
Choose an animal: Addison Anita Apollo Apollo 2 Buster Cali Cielo Darla Felix Fitzgerald Freya Freyja Gigi Ginger Goliad Grace Harmony Hazel Holly Jade Jade II Jessie Anne Kiki Lady Gaga Ladybird Lane Lucy Magnolia Miley Moody Oreo Pheebee Precious Rosie Scrappy Sophie Stella Stitch Valentino Whiskey Zeus 3

Why are you interested in adopting a pet at this time?*

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

How long have you lived there?*

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

If you rent, have you received the approval of your landlord and paid the pet deposit to have an animal?*
Choose one: N/A No Yes

If you rent, please enter your landlord's name and phone number for verification of pet acceptance (If not applicable, please type N/A)*

Please list any dog restrictions on where you live (i.e. weight, breed, number of dogs, etc. from your landlord, home owner's assoc or city/county)*

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

What is the height of the fence?*

What type of fence?*
Choose one: Chain Link Invisible/Electric Ranch Style Rod Iron Wood

Have you checked for escape routes?*
Choose one: No Yes

Will the animal be kept inside or outside?*
Choose one: Inside only Outside only Inside/Outside only when home

Where will the animal be kept when you are home?*
Choose one: Inside only Outside only Inside/Outside only when home

Where will the animal sleep?*

How much time will the animal spend alone during the day?*

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

List names & ages of people residing in your household (including you)*

Is anyone in your family afraid or uncertain around big dogs?*
Choose one: No Yes

What other pets do you have and their ages? (Please list name, breed and age of each pet)*

What traits are you looking for in a pet? (Check all that apply)

What do you plan to feed this dog? *

Who in the household will care for the pet and their age*

What type of activities do you plan on doing with your new dog?*

Are you prepared for the fact that a rescue dog may require housebreaking and that there may be accidents that happen on the furniture and rugs during the period that the dog is being trained?*
Choose one: No Yes

Dogs often live longer than 15 years. Will you be able to care for a dog that long?*
Choose one: No Yes

When you go on vacation, will your pet go with you?

If not, who will care for the pet in your absence?*

Describe how you will train the pet*

Do you know how to prevent heartworms?*
Choose one: No Yes

Do you have a current vet or one that can give a reference on a previous pet?*
Choose one: No Yes

If yes, Veterinarian's Name and Phone Number*

List at least one reference and number (who is not a family member)*

Have you applied with any other rescue?*
Choose one: No Yes

Have you ever given up a pet? If yes, please explain.*

Have you ever had a pet die of causes other than those related to old age?*
Choose one: No Yes

If, yes, please explain*

Are you planning on moving soon?*
Choose one: No Yes

If you do move in the future, what will you do if they do not allow pets?*

How did you hear about us?*

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