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First Name *
Last Name *
Home Address *
City *
State *
Zip Code *
Age *
Your Occupation *
Phone Number *
Email Address *
Who are you interested in adopting? *
Name of spouse/significant other? *
Significant other/spouse's occupation? *
Do you have any children? If yes, please list age *
Do you have any roommates? If yes, please list name and age *
Is everyone in the household aware you are interested in adopting a dog? *
Does anyone have pet allergies in your home? *
Who will be responsible for the dog? *
Are you aware dog can live 15-20 years and are willing to take on this responsibility? *
Why do you want to adopt a dog? *
Is this dog a gift? If yes, please explain *
What type of home do you live in? * Single family home Single family home Townhome Apartment Condo
Do you rent or own your home? * Rent Rent Own
How long have you lived at this address? *
Do you have plans of moving in the future? * Yes Yes No
If you rent, are dogs allowed? * Yes Yes No N/A
If you rent, please list the name and contact information of your landlord *
In what areas of your home will your dog be allowed? *
When you are not home, where will the dog be kept? *
Do you have a yard? * Yes Yes No
What type of fence? *
How tall is your fence? *
Does the fence fully enclose the yard? * Yes Yes No
If you do not have a fenced yard, how will your dog be let out? *
Do you have a pool? * Yes Yes No
If you have a pool, will dog be left unattended around the pool? Yes Yes No
If you have a pool, what will you do to ensure the dog’s safety? *
Do you have any toxic plants inside or in the yard? *
Do you have screens on your windows? * Yes Yes No
How many hours will your dog be left alone? Please be specific. *
Is this your first pet? * Yes Yes No
Where will your dog sleep? *
What type of lifestyle do you have? * Sedentary Sedentary Moderately active Very active
What activities will you do with your dog? *
Are you familiar with the breed you are interested in adopting? *
Do you currently have any pets? If so, please list name, breed, and age of all pets *
Do your current pets live indoor, outdoor, or both? Please list each pet *
Are your pets current on their vaccinations? * Yes Yes No N/A
Are your current current pets fixed? * Yes Yes No N/A
Will you keep your dog up-to-date on vaccines? * Yes Yes No
Have you had pets in the past? If so, please list name, breed, age and why you no longer have them *
If applying for a puppy, have you raised a puppy before?
Were you ever in a situation you could not keep your pet? If so, please explain *
In the event you are no longer able to care for your dog, who will be responsible for their care? Please include name and relationship *
What kind of food will you feed your dog? Please include brand *
What precautions will you take when introducing the new dog to your current pets? *
Are you okay with a home check * Yes Yes No
If a disciplinary or behavioral problem arises, what will you do? *
Is there anything else you would like us to know?
How did you hear about us? *
