Name of person filling out this application: *

Street Address *

City State ZIP *

Home Number

Cell Number *

Work Number

Email Address *

Best Time to Call *

Which Dog(s) are you interested in? *

Date you are available to welcome your new companion into your home if approved? * +

What is the Number of People in your Household? *

Please list the names and ages of each person in the household *

Which household member will be the primary daily caregiver of your rescue? *

What type of home do you live in? *

Is your town located in a town or rural setting? *

Do you own or rent your home? *

If you rent, please provide & phone of landlord: *We must receive written permission from landlord before adoption

Landlord Name

Phone Number

Do you have a fenced in yard? *

If no, how will ensure the safety of your rescue (please explain):

Where will your new pet live? *

Will your new pet be allowed on your furniture, bed, etc? *

Where will your new pet sleep at night? *

In the event you would have to move, what steps would be taken to secure a safe place for your pet? *

Do you or your spouse work? *

How many hours will your companion spend alone and where will he/she spend these hours? *

How long do you believe it will take your new rescue to adjust to your home? *

What method of house training will you use? (Please explain) *

How long do you foresee it taking you to house train? *

Please explain the methods of training that you will be using to deter chewing, jumping or other bad habits that your new pet may develop? *

Are you planning on or willing to take your new companion to formal training if needed? *

Please describe the activity level of your family and how your new pet will be involved in your everyday activities: *

Other pets currently living in your household (please specify cats/dogs/exotics) along with ages and breeds: Name & Type of Animal (cat/dog) Age Breed

Are your current pets spayed/neutered? *

If No please explain

Are your current pet(s) on monthly heartworm prevention & flea/tick preventative? *

How many dogs have you owned in the past? *

If you have owned one or more dogs in the past, please list their name and age and EXPLAIN what happened to them (old age, euthanasia, accident, gave away, illness, etc.)

If you previously had a dog was it on monthly heartworm prevention and spayed/neutered?

If no, please explain:

Please EXPLAIN how you are going to introduce your new rescue to the animals already in your home: *

Do you have a regular Veterinarian? *

If yes, please provide their name, address and phone number: PLEASE CONTACT YOUR VET TO GIVE PERMISSION TO RELEASE INFORMATION!!!

Have you ever turned a pet into a dog shelter or rescue? *

If yes, please explain the circumstances:

Why did you choose this pet? *

What is your size expectation for the pet you are applying for? *

Do you plan to breed this pet? *

If the rescue you are interested in has been noted to be special needs, please explain how your home and lifestyle will benefit these needs: *

If you rent, please provide & phone of landlord: ***We must receive written permission from landlord before adoption**

If you rent, please provide & phone of landlord: *We must receive written permission from landlord before adoption