First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Cell Phone

Date of Birth *

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

Name of spouse or partner-

Which dog are you interested in?
Choose an animal: Colby Jack Colt Delanie Havarti Kimber Maasai Mario No Nap Pockets Precious San Seraphim Too Small Winchester

How soon are you looking to adopt?
Choose one: Right away Next few weeks Few months Just browsing

What is your current employment status?*
Choose one: Employed Full Time Employed Part Time Unemployed Retired

Occupation?*

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

Do you have plans to move in the near future?*
Choose one: Yes No I don't know

How long have you lived at your current address?*

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

Do you live inside of city/town limits?*
Choose one: Yes No

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

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

How high is your fence?*

If you rent, does your lease agreement allow dogs or cats?
Choose one: Yes No

Does your lease have pet restrictions based on size or breed?*
Choose one: No Not Applicable Yes

If your lease has pet restrictions, please describe:

If you rent, how much is your pet deposit and monthly pet fee?

Landlord's name (If an apartment or 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

List the name and ages of all adults in your home.*

Do children live in the home?*
Choose one: Yes No

How old are the children in your home?
Choose all that apply: No children 0 - 6 years old 7 - 12 years old 13 - 18 years old

Do children visit your home regularly?*
Choose one: Yes No

Do any pets visit your home regularly?*
Choose one: Yes No

Is anyone in your home allergic to dogs and/or cats?*
Choose one: Yes No I don't know

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

My pets vet records are under what name and phone number? (If not sure list all possibilities)

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)

Some veterinarians, require you to give permission for them to release information about your pets. If required will you give permission? (PLEASE CALL YOUR VET NOW TO AVOID A DELAY)
Choose one: Yes No

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

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

Where will your pet(s) stay when alone?*

Where will your new pet(s) sleep?*

Who will be the principal caretaker of your new pet?*

Do you consider your pet a part of your family?*
Choose one: Yes No I don't know

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 fence all or part of your yard if necessary for your new dog?*
Choose one: Yes No

Will you attend obedience classes with your new pet?*
Choose one: Yes No I don't know

How do you plan on training your new pet and what methods do you plan on using?*

Will you attend obedience classes with your new pet if recommended or required in order to provide the best match possible for you and your new pet?*
Choose one: Yes No

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

Do you have a plan for your dog when you go on vacation or need to leave town for another reason?*
Choose one: Yes No

If so, what are your plans?

How much time do you want to spend grooming your new dog?*
Choose one: little to no brushing required 5-10 minutes monthly 5-10 minutes weekly 5-10 minutes daily over 15 minutes daily daily brushing & monthly groom

How much time do you want to spend exercising your new dog? *
Choose one: no daily execercise 20 minutes or less daily 20-30 minute walk daily 30-60 minute walk daily 30-60 minute run daily more than 30-60 minutes daily

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:

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:

Routine medical care for a dog can cost over $300 a year. This does not include emergency care, and other expenses like food, toys, and training. Can you commit financially to a new pet?*
Choose one: Yes No I don't know

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.

How did you hear about us?*
Choose one: Petfinder 1-800-save-a-pet Website Newspaper Flier Word of Mouth Other