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Name of person filling out this application:
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Street Address
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City State ZIP
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Home Number
Cell Number
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Work Number
Email Address
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Best Time to Call
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Morning
Afternoon
Evening
Which Dog(s) are you interested in?
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Date you are available to welcome your new companion into your home if approved?
*
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What is the Number of People in your Household?
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Please list the names and ages of each person in the household
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Which household member will be the primary daily caregiver of your rescue?
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What type of home do you live in?
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Single Family Detached
Townhouse
Condo
Apartment
Mobile Home
Farm
Other
Is your town located in a town or rural setting?
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Town
Rural
Do you own or rent your home?
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Own
Rent
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?
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Yes
No
If no, how will ensure the safety of your rescue (please explain):
Where will your new pet live?
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Inside
Outside
Both
Will your new pet be allowed on your furniture, bed, etc?
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Yes
No
Where will your new pet sleep at night?
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In the event you would have to move, what steps would be taken to secure a safe place for your pet?
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Do you or your spouse work?
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Adopter
Spouse
Both
How many hours will your companion spend alone and where will he/she spend these hours?
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How long do you believe it will take your new rescue to adjust to your home?
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What method of house training will you use? (Please explain)
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How long do you foresee it taking you to house train?
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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?
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Are you planning on or willing to take your new companion to formal training if needed?
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Yes
No
Please describe the activity level of your family and how your new pet will be involved in your everyday activities:
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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?
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Yes
No
If No please explain
Are your current pet(s) on monthly heartworm prevention & flea/tick preventative?
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Yes
No
How many dogs have you owned in the past?
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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?
Yes
No
If no, please explain:
Please EXPLAIN how you are going to introduce your new rescue to the animals already in your home:
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Do you have a regular Veterinarian?
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Yes
No
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?
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Yes
No
If yes, please explain the circumstances:
Why did you choose this pet?
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What is your size expectation for the pet you are applying for?
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Do you plan to breed this pet?
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Yes
No
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:
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