Date
*
Write in the style of 01/01/2023
MM
DD
YYYY
Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
(###)
###
####
Cell Phone
*
(###)
###
####
Email
*
Drivers License Number
*
Current Employer
*
Dog You're Applying For
*
Breed
*
Age
*
How Did You Find this Pet?
*
Do You Rent or Own your Residence?
*
Rent
Own
How long have you lived at your current residence?
*
Do you have any plans to move?
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Yes
No
Is anyone in your home allergic to dogs?
*
Yes
No
If yes, please explain
What pets have you had in the last 5 years?
*
If you have not had any pets in the last 5 years, please write N/A
If you no longer have any of the pets listed, where are they now?
*
If you have not had any pets in the last 5 years, please write N/A
What pets do you have currently? Please list Names, Breeds, & Ages of all current pets
*
If you do not completely fill out this section with breeds & ages, we may not consider your application. If you don't have any, please list N/A
Are your current pets spayed and neutered?
*
No
Yes
Are your current pets up to date on their vaccines?
*
No
Yes
What vet hospital have your current or former dogs been treated at?
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Name of the pet treated there
*
Phone number of the vet hospital
*
(###)
###
####
Do you give us permission to speak to your vet?
*
No
Yes
What heartworm prevention have you used in the past?
*
How often did you administer the prevention?
*
What flea prevention have you used in the past?
*
Where would your adopted pet primarily reside?
*
Where will the adopted dog stay when you are not home?
*
Where will the adopted dog stay when you are on vacation?
*
Who will be primarily responsible for the adopted dog?
*
How will you housetrain your pet or deal with accidents?
*
If any behavioral issues arise with your adopted dog what steps will you take to correct the issue?
*
For what reasons would you ever return a dog that you had adopted?
*
Do you have a fenced yard?
*
Yes
No
If you do not have a fenced yard, how will you exercise your adopted dog or let them go to the bathroom?
Do you feel you can train your adopted dog to be off leash?
*
Were your previous/current dogs allowed off leash in an unfenced area?
*
How many hours per day will your adopted pet be left alone?
*
Do you have the financial means to properly care for a dog knowing veterinary costs, food and accessories can reach upwards of $1000 annually?
*
Are you willing to financially care for your adopted pet if an emergency arises?
*
Yes
No
What type of emergency medical treatment would you not be willing to do?
*
Any other information you would like to tell us about yourself?
I certify that the information stated in this application is accurate and understand that just because I have applied to adopt a dog that doesn’t mean I will automatically be approved.
*
Our foster dogs are placed in the best suitable home based on the individual dog’s needs and background.
First Name
Last Name
