First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Canine's Name:*
Choose an animal: ***Ladybird ***Liza Jane ***Scout Duncan - NEW Dunkin - NEW Finn - New Judy - NEW - Fagin's Haven Lady - NEW Roger Woodstock-VIDEO (must be adopted with Snoopy)

Canine's Gender:*
Choose one: female male

List additional dogs of interest:

How did you hear about us?*
Choose one: Active Volunteer Event: Adoption Event: Other Canine Compassion Fund Website Repeat Adoption Adopt-a-Pet.com Petfinder.com AllPaws.com Facebook.com Dog.com Dogtime.com ASPCA.com Other website Word of Mouth

Applicant age: *

List any additional adult human household member's name, age, and occupation:*

Does anyone in your house have allergies to animal hair/fur/dander? *
Choose one: yes no

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

How long have you been at your current address? *

If you rent, has your landlord provided written permission for you to have a dog? :
Choose one: yes no

If you rent, landlord's phone number:

May we visit your home prior to application approval? *
Choose one: yes no

Do you have a fenced yard? (Note: Lack of a fenced yard does not necessarily preclude adoption.)*
Choose one: yes no

Do you have or do you plan to use an underground/invisible fencing? *
Choose one: yes no

Do you plan to keep this canine as an "inside dog?"*
Choose one: Yes, primarily inside. Yes, inside and outside. No, outside only.

Will the dog have free run of the house? *
Choose one: yes no

Do you plan to kennel train?*
Choose one: yes no

If you do plan to "kennel train," what is the maximum number of hours on any given day that the canine will be kenneled?

Please describe what would be a typical day for your dog. : *

Please describe what would be a typical night for your rescue dog : *

How many hours a day will your rescue dog be without humans? : *

How many hours are you away from home, including commute, daily? : *

How many children live in the home?*
Choose one: none 1 2 3 4 5 6 7 8 9

Ages of children living in the home (check all that apply):

Do you have any other pets?*
Choose one: yes no

If so, please list pet name, species, sex, age, and whether spayed/neutered.

If you were the owner of any dogs that are no longer with you, please provide a detailed explanation of what happened to those dogs:

Employer name and occupation:*

Work Phone #:*

Are you aware that the routine cost of maintaining a dog can be at least $750-1000 a year : *
Choose one: yes no

Do you understand the state and local ordinances concerning licensing and leashing? *
Choose one: yes no

Veterinarian Name (That you have used in the past three years. If you have never used this vet, but plan to use, please type "new" next to name):*

Veterinarian phone #:*

Previous veterinarian name and number:

In order to help us process your application quickly, please call your veterinarian and grant permission for us to conduct a vet reference. *
Choose one: I agree I disagree