First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone*

Work Phone
x

Cell Phone*

Today's Date*

Your date of birth (required)*

Applicant's Employment. Check one:*
Choose one: Full-time Part-time Work from home Temporarily unemployed Stay at home Retired

Name, address & phone number of your employer: (N/A if none)*

Name of spouse/other adults in home including age and relationship to you?*

Do you Own or Rent your home? (If you rent you are required to send us a copy of your pet lease agreement and a copy of fees and deposits paid.) If other than own or rent, please explain. *

How long have you lived at your current address?*

Landlord or Rental Company Name & Address, Phone: (write N/A if it does not apply)*

Are there any children (under 18) in the household? If YES, write ages, if NO write N/A. Have they had dogs before? How do they interact with dogs?*

Does anyone in the home have animal allergies?*

Please tell us about your family so that we can help ensure the best possible match for you and the adopted dog: Are you active, home a lot, adventurous, mellow?

What is the name or type of dog you are interested in? *

Is your yard SECURELY fenced? What type of fencing and how tall? (photos required)*

Please list all other pets in the household including Name, Age, Breed, Gender? Are they spayed or neutered? Are they up to date on Vaccinations? Please give a brief description of their temperament and play style:

How much time will the dog spend alone during the day? Where will the dog be kept while you are gone? Do you have a dog door?*

Name, address & phone number of your current veterinarian?*

Have you ever had to surrender or re-home a pet? Please describe circumstances:*

Have you previously owned pets? Are they deceased, surrendered, given away or still have them?*

What experience do you have with the type of dog you have chosen:*

How will you care for your pet when you are out of town? Please describe:*

While we make every effort to evaluate every dog in our care before placing them in appropriate well matched homes, we cannot guarantee any dog's behavior. Are you willing to accept these conditions and work with your adopted dog on any behavioral issues that may arise?*

Please add any other comments, concerns, or questions you may have:*

Will you allow a representative of Pets Without Partners to conduct a home check before adopting?

Please send any photos we may require: pet rental agreement, photos of yard and fence, etc. to www.petswithoutpartners@gmail.com

I understand that Pets Without Partners does not consider adoptions on a first come first serve basis, and may not be able to respond to every application. *I certify that the information entered on this application is true and correct. (Please enter your name and today's date.)*