EmailMe Form - Adoption Application

Dog interested in:

Name *

First Last

Phone *

### - ### - ####

Email

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Do you own or rent your home? *

Own

Rent

If you rent, you must be willing to provide a copy of your pet policy in your lease or written permission from your landlord to show that you can have the dog.

Daily work and at-home schedule *

Estimated Time with the Dog *

Veterinarian's Name and Address *

May we contact this veterinarian for reference information? *

Yes

No

First names and ages of ALL household members *

List types and ages of ALL household pets *

Are all pets in the home spayed or neutered? *

Yes

No

Approximate size of yard *

Type of fencing *

If no fence, are you willing and/or able to have your yard fenced of partially fenced? *

Yes

No

Where will the dog sleep at night? *

Where will the dog be kept when no one is home? *

Have you had dogs in the past? What breed(s)? If you have had previous dogs, please list what became of dogs. *

Under what circumstances would you not keep a pet? *

Have you ever been convicted of animal abuse? *

Yes

No

Why do you want a dog? *

Are there any specific habits or problems a dog might have that you are not willing to deal with? *

Have you adopted companion animals for shelters or rescue groups before? *

I have done volunteer work for/with animals. *

Yes

No

I realize that a rescue dog may need above average attention and training. *

Yes

No

I like high-energy, spunky dogs. *

Yes

No

Please provide 3 references and phone numbers. *