Today's Date: Applying to: Name of dog, if known:
Check preferences for dog:
Select preferred characteristics :
My new dog must be able to get along with:
Are you willing to take the time to housetrain a dog?
Do you understand that changing a dog's environment may cause the dog to have accidents?
If a behavior problem arises, what steps will you take to work on it?
Will you take obedience training if needed?
Does a member of your household have an allergy to animals?
If yes,
explain:
Who are you adopting the dog for?
How many people live in your home?
If children present, list: Number of boys: Ages:
Number of girls: Ages:
Who will be responsible for feeding and taking dog outside?
What kind of pets have you owned?
When you are home where will dog be kept?
Where will pet sleep?
How many hours will the pet be left unattended (e.g. workday)?
When no one is home, where will dog be kept?
How often do you travel?
What will you do with pet when you travel?
If you move, what will you do with the dog?
Have you, or your spouse, been in the military?
Have ALL ADULT family members agreed upon adopting the pet?
Has anyone in your family, or residing in your home, surrendered/relinquished a pet to an animal shelter or humane society?
Has any person residing in the home where the pet is to live ever been accused of, or convicted of, a crime involving cruelty to, or neglect of, an animal?
Have you ever had an application denied for adoption of an animal from an animal welfare group/animal control facility?
Do you currently have an application pending for a pet with another organization?
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C-1) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered?
Primarily indoor or outdoor?
When & how did you get the pet?
C-2) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered?
Primarily indoor or outdoor?
When & how did you get the pet?
C-3) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
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PREVIOUS PETS
(Pets you no longer have, but owned in the last six years) # of Previous Pets:
P-1) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
Year you last had pet?
Why you no longer have pet:
Cause of death or where pet is now:
P-2) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
Year you last had pet?
Why you no longer have pet?
Cause of death or where pet is now:
P-3) Name: Type: Breed/Size:
Age: Gender: Spayed/Neutered:
Primarily indoor or outdoor?
When & how did you get the pet?
Year you last had pet?
Why you no longer have pet?
Cause of death or where pet is now:
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List each veterinarian/animal hospital where your animal(s) received care during the last 10 years:
V-1) Name of vet or clinic:
Phone Number:
Owner name(s) records are listed under:
V-2) Name of vet or clinic:
Phone Number:
Owner name(s) records are listed under:
V-3) Name of vet or clinic:
Phone Number:
Owner name(s) records are listed under:
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Name of veterinarian to be used for this pet:
What type of home do you live in?
Do you own or rent your residence?
If you rent, Landlord name: Landlord Phone #:
What type of pets are allowed? Maximum Size:
If you have rented current residence for less than a year, provide prior address & landlord phone number:
Previous address:
Landlord's name: Landlord phone #:
Do you have a fenced yard? If yes, what type of fence?
How tall? (Give range of heights, if applicable): Any holes or gaps?
Does the fence belong to you or neighbors?
Do you want the dog to be:
How often will you exercise the dog? -for how long?