First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Age Applicant 1

Applicant 2 Name

Applicant 2 Last Name

Age Applicant 2

Tell us about your household:

Number of Children

Their Ages

Which best describes your current home? (select all that apply)

Please provide the name and phone number of your landlord (renters, parents) or land owner (mobile home).

Tell us why it's a good time to bring a new pet into your home.

Is there a particular pet on our web site that you are interested in adopting? If so, which one(s)?

Is there a specific activity that you want to do with your new pet?

Can you think of any reason that you'd return your new pet?

Do you have any pets currently? List type, breed, age & gender

Tell us about the pets you have owned over the last ten years. i.e. species, how many years owned, reason for no longer owning them.

Veterinarian's Name & Phone Number. Please also tell us what name the pet is under at the vet's office.

Are your pets current on vaccinations?

Are your pets spayed/neutered?

What brand of heartworm prevention do you use?

Completion of an 8 week level one obedience course is mandatory at adoption. Please do not complete the application process if you are not willing to attend training classes for socialization and bonding with your new dog. We can recommend many very good trainers in our area. Please as for a list if you need a referral. Which trainer do you plan to use with your adopted dog?

All of the dogs placed have undergone thorough temperament evaluations and have lived with foster families prior to their adoption.While in foster care, we begin training and work to resolve any behavioral obstacles before adoption. Generally we are only able to give you the dog's history from the time it enters our program. Are you able and willing to continue working on these challenges with us to ensure that your adopted dog is a respectable canine companion and family member? Your comments are encouraged.

Please provide the name and contact information of two persons who have been to your home and are able to discuss your interactions with your pets. Reference #1 (name, relationship, evening phone number, email address):

Reference #2 (name, relationship, evening phone number, email address):

Additional Comments:

I certify that the information I have provided on this form is true, correct, and accurate. I am financially and physically able to care for the animal. I understand and agree that falsification of any of the above information is grounds to disqualify my application. I understand that there is no obligation to offer an animal to me, now or in the future. I understand that my electronically-generated signature [below] is valid as a means of legal signature for the purpose of this application (Yes or No)

Signature*

Date*