First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Cell Phone

Alt Email

Date of Birth *

Name of spouse or partner-

Please fill out the application COMPLETELY. An incomplete application will cause a delay in processing.

Which dog are you interested in?
Choose an animal: Belle Breaker Charlotte Crimson Dacs Drax Elvis Leila Marble Matilda Monkey Razz Titan Tuff Tuff

Do you own or rent your home?*
Choose one: Own Rent

What type of home do you live in?*
Choose one: Apartment Condo Farm House Mobile Home

Does your homeowner's association or insurance and/or city have restrictions on breeds, size and number of pets? (If yes, please check with them)

Do you have a fenced yard?*
Choose one: Yes No

What type of fence?
Choose one: Privacy Chain Link Invisible

If you have a fence, what is the height?
Choose one: 3 foot - 5 foot 6 foot - 8 foot Over 8 foot

If you rent, does your lease agreement allow dogs and cats and are there restrictions?
Choose one: Yes No I don't know

Landlord's name (If a complex, list manager's name and/or rental office)

What is your landlord's phone number?

What is your landlord's email address?

How many adults live in your home?*
Choose one: 1 2 3 4 5 6 7 8 9 10

How old are the children in the home?
Choose all that apply: No Children 0-2 3-5 6-11 12-17

What is your families lifestyle and activity level?
Choose all that apply: Active and on the go Lots of kids in and out Entertain frequently Travel frequently Quiet and relaxed

Is someone home during the day?*
Choose one: Yes No

Do you have a home based daycare, babysit or have children visit?*
Choose one: Yes No

The vet records are under what name and phone number? If you are unsure list all possibilities. TO AVOID DELAYS, LIST ALL POSSIBILITIES AND CALL YOUR VET'S OFFICE AND GIVE THEM PERMISSION TO SPEAK WITH OUR REPRESENTATIVE!

List all current pets by their name and what type of animal they are(e.g. Sparky, dog).

List the name of your CURRENT (or most recent) veterinarian

Your current vet's phone number is

List any pets you have owned in the past 10 years that you no longer have by name and type of animal.

List the name and phone numbers of all veterinarians used within the PAST 10 years. (list all regular and emergency vets)

What traits/characteristics/habits are you looking for in your new pet?*

What traits/characteristics/habits do you NOT want in your new pet?*

Primarily lives*
Choose one: Both inside and outside Inside Outside Outside in a fenced area Outside on a chain or leash

How will you contain your dog while outside for bathroom breaks and exercise?*
Choose one: Fence Leash Walk Tie to porch, doghouse, tree, Cable tie-out or runner No Containment

Where will the pet stay when left alone?*
Choose one: Garage Indoors Crated Indoors Outside in Fence Outside Tethered/tied Outside Dog Lot/pen

How long will the pet(s) be alone each day?*

Will you have your pet spayed or neutered?*
Choose one: Yes No

Will you keep your dog current on heartworm prevention medication?*
Choose one: Yes No

Are your current pets up to date on their vaccinations and monthly preventatives?*

Are you willing to housetrain a dog?*
Choose one: Yes No

Have you ever had to euthanize a pet?*
Choose one: Yes No

If yes, please explain

Have you ever had to return or surrender an animal in the past?*
Choose one: Yes No

If yes, please explain:

Under what circumstances might you want to return the pet to us? Select all that apply.
Choose all that apply: Behavior/aggressive problems Housebreaking issues Job Change Moving New Baby New Job None of the above Too time consuming/not enough time for pet

If for some reason you are not able to care for this pet in the future, do you have a plan for someone to take over and care for your pet?*
Choose one: Yes No

If yes, please explain:

If the dog you are interested in is no longer available, would you like to hear about other dogs that might be a good match for your family?*
Choose one: Yes No

Please list any additional information you would like us to consider when reviewing your application, or list any questions you have below.

List two (2) references including name, phone number, and email. (No family members)*

Before submitting your application

• Make sure all information is correct and that you have answered all questions. If one does not apply put NA.
• List all pets you have owned over the past 10 years and make sure you list the correct contact information for your veterinarians.
• List your landlord/complexes information including the name and phone number

Please understand  that submitting an application does not mean you are committing to a dog or cat, nor does it guarantee you will be approved to adopt from Cabarrus Pets Society Rescue .