First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Cell Phone*

Why do you want to adopt this dog? (check all that apply)

How many people reside in your household*

Are there children in your household? If yes, please list ages*

How long have you been looking for a pet?*

What have you done to prepare for the pet?*

Which animal are you interested in*
Choose an animal: Bailey Brenna Brownie (8th St litter) Cheeto Colby (cheese litter) Dorito Easter Funyun Genny from the block Hannah Hudson Janury Jazzy Karma Lil Miss Maxi Maxine maybelline #24099 Nugget Oden prince princess Princess Pringle Rain Romano (cheese litter) Rosemary Rowdy Ruffles Shelly Tessa

Will the animal be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

Are there other pets in the household? How many and what type?*

If you have other dogs, please list their breed and age

Are they spayed or neutered?
Choose one: Yes No

Are they up to date on their vaccinations?*
Choose one: Yes No

Do they receive heart worm preventative?
Choose one: Yes No

What would you like us to know about the other animals in your household?

If you have no dogs at this time, have you owned one in the past?
Choose one: Yes No

How long do you plan to keep the pet?*

Who in the household will care for the pet?*

Are you prepared to budget for the expenses associated with routine care of the pet and for possible emergencies which may arise?*

Veterinarian's Name and Phone Number*

The pet is on monthly heart worm and flea prevention and has all required vaccinations. Do you agree to continue your dog's regimen of heart worm and flea prevention and keep your pet's vaccinations up to date?*
Choose one: Yes No

Do you live in a house or an apartment?*
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, do you have prior approval from the manager or owner to keep a pet?
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

How long have you been at this residence?*

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

Where will the pet be kept when you are away from home? (check all that apply)

Where will the animal be kept when you are home? (check all that apply)

Describe how you will train the pet. Leash training, house training, chewing, etc.*

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

If no fenced yard, how will your dog get exercise?

What will you do with your pet if circumstances change, and you can no longer give it the attention and care that it needs?*

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

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