Applicant Full Name
Co-Applicant Full Name
City, State & Zip Code
Is there a specific dog you are interested in?
If so, please provide info on dog such as name, number description and location of dog you are requesting
Why are you interested in this particular dog?
Please provide the age of the dog you prefer.
Would you consider a special needs dog? One who requires medication
Would you accept a mixed breed?
What is your desired activity lebel Low, Med, High
Please provide the sex you prefer
It doesn't matter
How many people live in your household?
Please provide the ages of all individuals who live in your household.
Who will care for, train and exercise this dog?
Who is this dog primarily for? (Adult, Child or Elderly)
Do others visit your home often?
Does anyone in your household have allergies?
May we visit your home prior to approval of the application?
Please list all the most recent pets you have owned in the past: Dogs or Cats? Male or Female?
Were all of these pets spayed/neutered?
What happened to these pets?
VERY IMPORTANT! Please provide the name, city & state and phone number for your current veterinarian.
Please identify any other veterinarians you have used recently. Name, City & State and Phone number
Do you rent or own your home?
If you rent, do you have your landlords permission to have a dog? If so, up to what size?
What is your landlords name and phone number?
Will the dog be allowed in the house?
How long daily will the dog be without supervision (of humans)
Where will the dog stay when you are away from the house?
Is your yard fenced?
What type of fence?
Approximate size of dog's yard area.
Will the dog be walked daily?
Ever allowed to roam freely without supervision?
Receive formal obedience training?
Are you aware that the average annual cost for owning a dog is $500/year?
Have you ever sold, given away or surrendered a pet to a shelter?
If so, please specify why
Please tell us why you want a dog?
Please tell us about the kind of activities you would want to partake in with your new dog. Any information about your family life or lifestyle can be used to help us to properly match dog to your needs.
If you were to move what would you do with your dog?
Do you understand the local ordinances with regard to licensing and leashing?
Have you or any member of your family been cited for leash law violations or ruelty to animals in the past?
If yes, please specify
When you go on vacation where will your pets be kept?
I attest that the information provided on this application is true and accurate to the best of my knowledge and I understand that the completion and submission of this application does not guarantee adoption of a dog.
Should be Empty: