| First and Last Name: | |
| Spouse/Roommate's Name: | |
| Street Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Phone Number (including area code): | |
| Mobile Phone Number (including area code): | |
| Work Phone Number (including area code): | |
| Email Address: | |
| Is there a particular dog/puppy you are interested in? If so, please provide a name or description: | |
| Do you live in a: | |
| If other, please explain: | |
| How long have you lived at your present location? | |
| Do you rent? | Yes
No
|
| If yes, do you have permission to have a pet of this type and/or size? |
|
| May we contact your landlord? | Yes
No
|
| Landlord's Phone Number: | |
| Are there screens on all doors and windows that you open for ventilation? | Yes
No
|
| Would you object to an inspection of your home? |
|
| Where will the dog be kept? | |
| If other, please explain: | |
| Do you have a fenced in yard? | Yes
No
|
| How many hours per day will the dog be left alone? | |
| Where will the dog be kept during this time? | |
| Do you plan to keep an I.D. tag on this dog? |
|
| Is anyone in your household allergic to animals? | Yes
No
|
| How many dogs do you currently own? | |
| How many cats do you currently own? | |
| How many other pets do you currently own? | |
| Please list breed, sex, age, spay/neuter status, and how long owned for all current pets: |
|
| What is the name and phone number of your current veterinarian? | |
| How many children are in your household (both full-time and part-time)? | |
| Please list their ages: | |
| On the first night home, where will the dog stay? (Please be specific): | |
| Who will be responsible for this dog? | |
| Have you owned a dog before? | Yes
No
|
| Please provide details about all previous dogs owned, including where they are now. If deceased, please give the cause of death, and how long ago they died: |
|
| Dogs have been known to bark out of boredom, chew furniture and personal articles, dig holes in yards, and may exhibit other behaviors that you find unacceptable. How do you intend to handle any potential problems of this type? |
|
| Even healthy dogs require routine veterinary care. What would you estimate the annual cost of preventative veterinary care to be? | |
| If this dog were to become sick or injured, are you willing and able to provide adequate veterinary care? | Yes
No
|
| How soon after the dog arrives home will it be left alone? | |
| How often do you go out of town? | |
| How will your dog be cared for while you are away? | |
| What will happen to the dog if you move locally? | |
| What will happen to the dog if you move out of state? | |
| What will happen to the dog if you move overseas? | |
| Did you know that the life expectancy of a dog is 10 to 15 years? Are you willing to take responsibility for your dog's entire life? |
|
| Under what circumstances would you NOT keep this dog: | Divorce
Move
New Baby
New Job
Ilness
Other
|
| If other, please explain: | |
| Why do want a dog? Check all that apply | Companion for self
For Child
For Spouse
Companion for another Pet
Gift
For Protection
Other
|
| If other, please explain: | |
| If applicable, what made you choose this particular dog? | |
| I certify that the above information is true, and that any false information may result in nullifying of the adoption and forfeiture of any fees paid. |
|
| Application completed by: | |
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