Desired Dog:

Applicant First Name:

Applicant Last Name:

Applicant Age:

Co- Applicant First Name:

Co- Applicant Last Name:

Co- Applicant Age:

Address:

City:

State:

Zip Code:

Email:

Home Phone:

Alt Phone:

Best time to call:

Do you smoke?:

What kind of dog food do you feed?:

Why want to Adopt:

Others in Household:

Age:

Relationship:

Other Applicant 2:

Age 2:

Relationship 2:

Other Household 3:

Age 3:

Relationship 3:

Do Children Visit:

Who will be caretaker:

Type of home:

Own or rent:

If Rent Landlords Name:

Landlords phone:

If rent statement:

If rent  lease:

How long at residence:

Fenced Yard:

(We do not adopt out to people with electric fences)

If yes type of fence:

Do you have a problem taking the dog to obedience classes?:

How will do get exercise:

Is there a swimming pool on property:

Where will dog be when left alone:

Where will dog sleep at night:

Do you have a problem using a crate:

How many hours will do be left alone:

Other Pets in household:

Type/Breed:

Age:

Gender:

Spay/Neut:

Type/Breed 2:

Age pet2:

Gender pet 2:

Spayed/Neutered pet 2:

Type/Breed pet 3:

Age pet 3:

Gender pet 3:

Spayed/Neutered pet 3:

 PLEASE BE SURE TO CONTACT YOUR VETERINARIAN TO LET THEM KNOW THEY CAN RELEASE YOUR INFO TO US.

Veterinarian name:

Vet adddress:

City vet:

State Vet:

Zip Vet:

Phone Vet: 

Have you applied with any other rescue?:  

Date Applied:

Any additional information that would be helpful: