First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone*

Alt Email

What is your employment - Your employer*

Which animal are you interested in
Choose an animal: lucy

Have you owned dogs before. Please list type and where they are now*

What traits are you looking for in a pet

List at least two references (who are NOT family members) with Phone Numbers*

Where will the animal be kept when you are home*

Where will the animal sleep*

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

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

Describe how you will train the pet

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

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

How did you hear about us*

Is your yard fenced*
Choose one: Yes No

What is the height of the fence

What type of fence
Choose one: Chain Link Invisible (Not acceptable) No Fence- Will leash walk Privacy

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

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

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

Veterinarian's Name and Phone Number*

Adopters Age in years*

How many people reside in your household*

Has everyone in the family agreed to this adoption

Ages of minors residing or frequently visiting in the home*

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

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