Adoption Application

*Full Name

*Street Address
City      State   AL      AK      AR      AZ      CA      CO      CT      DC      DE      FL      GA      HI      ID      IL      IN      IA      KS      KY      LA      ME      MD      MA      MI      MN      MS      MO      MT      NE      NV      NH      NJ      NM      NY      NC      ND      OH      OK      OR      PA      RI      SC      SD      TN      TX      UT      VT      VA      WA      WV      WI      WY         *Zip Code

Home Phone      Mobile Phone
Work Phone      Best time to call

*Email

What specific dog are you interested in?

Have you applied to other rescues?   Yes   No
If yes, give name(s)

*Vet's Name or Alternate
Address
*Phone

List all people in your household (including children):
Name      Age      Sex
Name      Age      Sex
Name      Age      Sex
Name      Age      Sex
Name      Age      Sex
Name      Age      Sex

List any regular visitors to your home (human and animal), with which your new dog must get along

*Do you own any dogs?   Yes   No       Spayed/Neutered?   Yes   No
Please list each dog:
Breed      Age      Sex
Breed      Age      Sex
Breed      Age      Sex

*Do you own cats?   Yes   No      How many?      Indoor   Outdoor

*Do you own other animals (rabbits, parrots, etc)?   Yes   No
If yes, list

*Do you own livestock?   Yes   No
If yes, list

How many dogs have you owned in the last 5 years?
Do you still own the dogs?   Yes   No
If not, what happened to the dog(s)

*Do you own or rent your home?   Own   Rent

If you rent, do you have your landlord's permission to keep a dog?   Yes   No
Landlord's Name      Phone

Do you live in a   House   Apartment   Mobile Home   Condo   Other
If other, describe

How long have you lived at your current residence?

Do you plan to move in the near future?   Yes   No

*Do you have a fenced yard?   Yes   No
If yes, list fence type (chain link, wood, etc) and height
If yes, does the fencing completely enclose the yard?   Yes   No

Do you have a separate kennel run?   Yes   No

Why did you choose this dog?

List all plans for this dog   Pet   Guard   Obedience   Livestock Guardian

Do you want to adopt   Male   Female   No Preference

Age preference?   Less than 4 mths.   4 mths. to 1 yr.   Adult   Senior

*Where will the dog spend the day? (mark all that apply)
Indoors   Crate   Garage   Fenced Yard   Kennel   Run
Tie Out/Trolley   Daycare   Other
If other, describe

*Where will the dog spend the night? (mark all that apply)   Indoors   Crate
Garage   Fenced Yard   Kennel   Run   Tie Out/Trolley   Other
If other, describe

How many hours a day, on average, will the dog spend alone?

If applying for a puppy, how will you handle potty breaks during work days or prolonged absences?

Will you commit to taking your dog/puppy to obedience school?   Yes   No