First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Name of pet you are interested in:
Choose an animal: Chompers Eddie Iris Leo Luna Maddie Mascarpone Maximus Meiko Millie MuShu Osito Poppy Qi Sasha Tamara Tate Tyrus

Please list any alternate or second (if you are interested in a pair) dog names you might be interested in.

What is the best number/time to call you?*

May we contact you at work if necessary?

How often do you check your e-mail?*

Are you over 18?*
Choose one: Yes No

Occupation:*

Employed by:*

How long there?*

Work address and phone:*

Marital Status*

Number of children and ages:*

Do children regularly visit your home?*

Are there any other members of your household? (grandparents/friends/roommates/etc) Please list first name, age and relationship

Please list breed, age and sex of all other dogs in the household:*

Spayed or neutered? If NOT, please explain why not...*

How long have you owned each dog?*

How many cats share the household (age, sex, spayed/neutered)?*

Any other pets? Ferrets, hamsters, snakes, birds, etc?*

What happened to previous pets (i.e.- family dog died, ran away, etc)?*

We live in a (house, apartment, etc):*

Which we (own, rent, etc.):*

Landlord (name, address and phone):

Our neighborhood/property is (rural, suburban, urban):*

Do you have a yard, and is it securely fenced?*

Please describe your fence briefly (material used, when installed or age, height):*

Please tell us anything further about you or your family that you'd like to share:

Do you have a preference on male or female?*
Choose one: Male Female No Preference

Do you have an age preference for dog?*

We expect all applicants to come to meet their dog in person. Are you willing to travel to pick up a new dog?*

If willing, how far are you will you travel to pick up new dog (please tell us miles or states)?*

Are you looking for a purebred or would you consider a mix?*

Generally speaking, what sort of temperament are you looking for in a pet?*

What type of issue would cause you to consider giving up this pet?*

If the pet became lost, what would you do?*

Are you familiar with crate training?*

Where will the pet stay when alone?*

On average, how many hours a day will the pet spend alone?*

Where will the pet sleep?*

Please outline any expectations or concerns you may have:

Please provide two personal references we may contact. References should know you and your home well, and at least one should be unrelated to you. Please provide names and phone numbers.

Name, Phone, Alternate Phone*

Name, Phone, Alt Phone*

Please provide the name, address and phone number of at least one other person who we may contact if we are unable to reach you in an emergency.

Name *

Home Phone , Cell / Work Phone*

Address*

Please provide the name and address of your veterinarian, or one who has treated your pets in the past. ( Name of Vet Practice, Address, Phone )

Finally, have you rescued an animal before? If so, please let us know what rescue or shelter (animal - dog, cat, etc; rescue/shelter name and state).

When filling out online or mobile, after pressing the SUBMIT button, be sure to scroll up and make sure there are no errors.  You will receive a confirmation email when your application is submitted successfully.