DOG ADOPTION

First Name *

Last Name *

Home Address *

City *

State *

Zip Code *

Age *

Your Occupation *

Phone Number *

Email Address *

Who are you interested in adopting? *

Name of spouse/significant other? *

Significant other/spouse's occupation? *

Do you have any children? If yes, please list age *

Do you have any roommates? If yes, please list name and age *

Is everyone in the household aware you are interested in adopting a dog? *

Does anyone have pet allergies in your home? *

Who will be responsible for the dog? *

Are you aware dog can live 15-20 years and are willing to take on this responsibility? *

Why do you want to adopt a dog? *

Is this dog a gift? If yes, please explain *

This dog will be a… (Check all that apply) *

• Companion
• Companion for another pet
• Protection
• For child

What type of home do you live in? *Single family homeSingle family homeTownhomeApartmentCondo

Do you rent or own your home? *RentRentOwn

How long have you lived at this address? *

Do you have plans of moving in the future? *YesYesNo

If you rent, are dogs allowed? *YesYesNoN/A

If you rent, please list the name and contact information of your landlord *

In what areas of your home will your dog be allowed? *

When you are not home, where will the dog be kept? *

How will they be kept? *

• Crate
• Run of the house
• Backyard
• Kennel
• Access to doggie door
• Dog house
• Garage
• Other

Do you have a yard? *YesYesNo

What type of fence? *

How tall is your fence? *

Does the fence fully enclose the yard? *YesYesNo

If you do not have a fenced yard, how will your dog be let out? *

Do you have a pool? *YesYesNo

If you have a pool, will dog be left unattended around the pool?YesYesNo

If you have a pool, what will you do to ensure the dog’s safety? *

Do you have screens on your windows? *YesYesNo

How many hours will your dog be left alone? *

Is this your first pet?YesYesNo

Where will your dog sleep? *

What type of lifestyle do you have? *SedentarySedentaryModerately activeVery active

What activities will you do with your dog? *

Are you familiar with the breed you are interested in adopting? *

Do you currently have any pets? If so, please list name, breed, and age of all pets *

Do your current pets live indoor, outdoor, or both? Please list each pet *

Are your pets current on their vaccinations? *YesYesNoN/A

Are your current current pets fixed? *YesYesNoN/A

Will you keep your dog up-to-date on vaccines? *YesYesNo

Have you had pets in the past? If so, please list name, breed, age and why you no longer have them *

If applying for a puppy, have you raised a puppy before?

Were you ever in a situation you could not keep your pet? If so, please explain *

In the event you are no longer able to care for your dog, who will be responsible for their care? Please include name and relationship *

What kind of food will you feed your dog? Please include brand *

What precautions will you take when introducing the new dog to your current pets? *

Are you okay with a home check *YesYesNo

If a disciplinary or behavioral problem arises, what will you do? *

Is there anything else you would like us to know?

How did you hear about us? *

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