EmailMe Form - SECOND CHANCES FOR BLIND DOGS APPLICATION

Blind Dog of Interest *

Applicant's Name: Age *

Name of Spouse/Roomate & Age
Name of Children & Ages

Address *

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

Home Telephone

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

Mobile Telephone *

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

Email *

Type of Residence *

RESIDENCE
1) Number of gates & type of lock
2) Height/type of fencing
3) Swimming pool: Is it fenced?
4) Balcony: Is it enclosed? *

Landlord's Name & Telephone
Is there a pet deposit & weight limit?

List 3 Personal References (Name/Relationship/ Telephone) *

1) Have all the adults in the household agreed to adopting the pet?
2) Is anyone allergic to the dog?
3) Does anyone in your household smoke? *

1) Who is the primary caretaker of pet?
2) When & How often are you planning to exercise you pet? *

1) How many hours will your pet be alone?
2) Where will your pet stay when you are not home? *

1) Where will your pet sleep at night?
2) How do you plan to provide for your pet when you are out of town? *

1) What would you do with your pet if you moved or relocate out of state?
2) Under what conditions would you NOT keep your pet? *

DIET
1) What Brand of food would you feed your pet?
2) What kind of food will you feed your new pet?
Dry, Canned, Homemade, Raw, Freeze Dried *

OBEDIENCE TRAINING
1) Do you have experience with obediance training?
2) How would you discipline your pet if they misbehave?
3) What would you do if inappropiate behavior continues? *

1) Can you afford regular, serious or illness veterinary care?
2) Please list current Veterinarian/ Animal Hospital/ Clinic
3) address & phone number *

PET HISTORY
1) Name/ Breed
2) Gender: Sterilized
3) Vaccinated
4) Ages own/ still have
5) What happened to the pets you longer have?

PET HISTORY
1) Name/ Breed
2) Gender: Sterilized
3) Vaccinated
4) Ages own/ still have
5) What happened to the pets you no longer have?

1) Have you ever bred a dog?
2) Please tell us why you are interested in adopting a dog?

The adoption is for the lifetime of the dog.
1) Are you willing to send photos of your home and get a homecheck for the safety of the animal? *