Adoption Application

Today's Date *

Name of Desired Dog *

First Name *

Last Name *

Date of Birth *

E-mail Address *

Spouses Name

Home Telephone

Cell Phone *

County Residence *

Street Address *

Street Address

City *

State *

Zip Code *

Length of time at above residence *

Do you live in a: *

Do you rent or own? *

Rent

Own

If rent, are pets allowed?

Yes

No

If Renting, Landlord Name/Agency

If Renting, Landlord Telephone Number

Employer *

Job Occupation *

Work Phone Number *

Name and ages of everyone in household including children *

Does anyone in your family have allergies to pets? *

Yes

No

Does everyone in household want a new pet? *

Yes

No

Describe your family's level of activity. Do you enjoy active fun outdoors or quiet time at home? What activities would the dog be doing with your family? *

Where would the dog be kept? *

Do you have a fenced-in yard? *

Yes

No

Have you ever housebroken a dog/puppy before? *

Yes

No

Have you used crate training before? *

Yes

No

Any other pets in your house? List all pets and if they are spayed/neutered. If you have no other pets just type in "No". *

Please provide the name, address, and phone number for a reference from your veterinarian.

Please be aware that owning a dog is a big financial responsibility. Regular vet visits, food, training, toys, treats, medical bills, etc. cost on average $800 per year. Are you willing to take on the financial responsibility? *

Yes

No

Most dogs live for 10-20 years, depending on the breed, and we only adopt to families who are willing to make that kind of commitment. Are you prepared to make such a long-term commitment? *

Yes

No

Please provide the name, address and phone number of 3 personal, non-family member, references:
Reference #1 *

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Reference #2 *

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Reference #3 *

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