Date

Applicant Name(s)
Street address
City State Zip Code
EmailCell Phone
Home Phone Work Phone
Occupation of Applicant(s)

Name and ages of all household members, including yourself

Do any members of your household have pet-related allergies?

Describe your current pets. Include name, age, sex, and breed of each.

Veterinarian's name Vet Phone
Any additional vets used and their contact info:
Are your pets spayed/neutered? Yes No
If not, what is the reason?
Are your pets up to date on vaccinations and heartworm preventative? Yes No
If not, when can you have this done?
How many hours will your pet be alone during the day?
Where will the dog be kept during this time?
Where will the dog sleep at night?
Have you had any other pets in your adult life? If so, how long did you own them and what happened to them?

Previous Vet's Name and Phone Number (if different from current pets)

Do you have a fenced yard?   Yes    No
If so, what is the fencing material/type? Height?
Are any repairs needed to keep a small dog from escaping?
How long have you lived at your current address?

Type of Housing?
Home     Condo     Apartment    Mobile Home   RV    Ranch

I Own   I Rent    I have other arrangements (please describe below)

Name of Apartment Complex or Trailer Park?
Manager/Landlord Name   Phone
Any restrictions on pets?   Yes    No
If so, please describe
Are you planning on moving in the near future?  Yes    No
If so, how soon and what would you do with your pet?
Do you have friends/relatives that visit with small children or their pets that this dog would be expected to interact with?
Please list any other rescue groups/shelters that you have adopted pets from in the past.
Please discuss any rescue group or animal shelter you have volunteered with in the past.
How long have you been looking for a pet?
Before seeing the dog that you are applying for, what kind of dog were you looking for and what personality traits were desired?
Name of adoptable dog or type of dog you are seeking:
Reason for selecting this particular dog or breed?

I am interested in (check all that apply)
Male   Female   Puppy (0-1 year)   Adult (2-9 years)   Senior (10+ years)

I want a pet because:

What is the activity level of the dog you are looking for?

What do you consider undesirable traits?

What would you do if you saw some of the above listed traits in the dog that you adopted?

If the dog you adopted had some training needs, have you been to training classes before?
If no, are you able to take them to a professional trainer?

How will your dog be confined to your property?
Examples include in house, in crate/kennel, in fenced yard, on a chain/tether, in a garage, on a patio.

If you live in the country, how will your dog be confined?

How much exercise and what type of exercise do you plan to give your dog?

In what manner will you be transporting your petin your vehicle?

How long do you feel that a dog should be given for an adjustment period?

Who will be responsible for the socialization, medical care, and training of this animal?

Describe your method of housebreaking (even housetrained dogs have accidents at first):

What grooming requirements do you feel are necessary for this particular dog?
Excluding your death, what circumstances would cause you to give up an animal?

What time period do you require to prepare for a new dog (if any)?

What brand of food will your dog eat?
On average, how much do you expect to spend annually on this dog (including heartworm preventative, flea/tick preventative, vetting, toys/treats, grooming, etc.)?

There are times when unexpected and often costly medical conditions occur. What would you do if this happened to your pet?

If you are applying for a puppy, please describe your reasons for wanting a puppy versus an older dog:

Are you willing to allow a representative of this group visit your residence?  Yes    No
How did you find out about our organization?

I am interested in helping out this group in the following ways (check any that apply):
Fostering a homeless dog   Adoption Day helper
Tranport dogs to vet   Home visits for potential adopters
Interviewing adoption candidates   Fundraising

What is the best way to contact you?

Any additional comments or things we did not ask that you would like us to know?

Clicking "Send it!" will launch your mail application and then you will send the form to us by sending the email.