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Name *

Street Address *

City, State *

Zip Code *

Phone

Email *

Name of pet that you are interested in

Where are you employed*

Occupation *

Work Phone *

Spouse's Name *

Spouse's Occupation *

Our adoption process includes a home visit. Are you willing to let a representative visit your home by appointment? *
—Please choose an option—YesNo

If you answered no to the previous question, please explain.

Personal non-family reference #1 (Name, Phone, Relation) *

Personal non-family reference #2 (Name, Phone, Relation) *

What is your reason for wanting to adopt a pet at this time? *

Description of residence *
—Please choose an option—Single Family HomeApartmentCondo Or TownhouseMobile HomeOTHER

Do you... *
—Please choose an option—OwnRentOTHER

If you are renting, what is the name of the property, property owner, and phone number? *

Does your Homeowners Association have any restrictions on pet ownership?
—Please choose an option—YesNo

If you answered "YES" Above, Please Explain.

Do you have a fenced yard? *
—Please choose an option—Wood PrivacyIronChain LinkInvisible FenceNoOther

Fence Height *

Number of adults in the house *

Number of children in the house *

Who will care for this dog? *
—Please choose an option—MyselfMy SpouseMy ChildrenOTHER

Where will you keep the dog during the day? *
—Please choose an option—Fenced YardKennel RunInside HomeTied OutsideGarageLoose OutsideCratePatio/BalconyOTHER

Where will you keep the dog at night? *
—Please choose an option—Fenced YardKennel RunInside HomeTied OutsideGarageLoose OutsideCratePatio/BalconyOTHER

Where will you keep the dog while you are away? *
—Please choose an option—Fenced YardKennel RunInside HomeTied OutsideGarageLoose OutsideCratePatio/BalconyOTHER

On average, how many hours will the pet spend alone? (please specify daily or weekly) *

On average, how many hours will the pet spend outside by itself? (Please specify daily or weekly)

How will you handle this pet's exercise and potty breaks? *

Please list all animals currently living at your address and any pets you have owned in the last three years: (please include age, species, breed, and sex) *

Spayed/Neutered *
—Please choose an option—YesNo

If you answered "no" to the above question, please explain.

Vaccinated *
—Please choose an option—YesNo

If you answered "no" to the above question, please explain.

What happened to the pets that are no longer with you? *

If adopting a dog, will you obedience train the dog? *
—Please choose an option—YesNoOTHER

Please describe the extent of care that you are willing to provide should your pet have special medical needs now or later in life. *

Will you have your pet vaccinated annually by a veterinarian?
—Please choose an option—YesNoOTHER

Please describe what you know about the causes and prevention of heartworms. *

How will your pet be cared for when you are out of town? *
—Please choose an option—BoardingLeave at home with food and waterDog SitterLeave with a friendTake with youOTHER

If you currently have a veterinarian, please provide the name, address and phone number. *

Have you owned this breed/mix before?
—Please choose an option—YesNo

Have you owned a rescued animal before?
—Please choose an option—YesNo

Have you ever adopted from a rescue group or shelter? *
—Please choose an option—YesNo

If "yes", please provide the name of the rescue or shelter.

Have you applied to adopt an animal and been declined? *
—Please choose an option—YesNo

If "yes" please explain.

Have you ever given up an animal? *
—Please choose an option—YesNo

If "yes", what did you do with the animal(s) and why? *

What qualities are you looking for in a pet? *

What traits or characteristics are you sure you do NOT want? *