Application

Please select if you are applying for Adoption or to become a Foster*

If you are applying for a specific Dog or specific breed do you have experience with that breed*

Name of the dog that you are applying for.*

If the dog you are applying for is no longer available, do you what to be screened for a future dog?*

YesNo

Which gender of Dog do you prefer?*

Age Preference (check all that apply)*

Are there any specific characteristics you are looking for?*

(Good with Kids, Dog Friendly, Etc)

What purpose will your new Dog serve in your life? ( please check all that apply)*

If you answered "Other", please elaborate.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Date of Birth*

Date

Best number to reach you*

Please enter a valid phone number.

Email*

example@example.com

Employer*

Work hours per day*

Work hours per week*

How many hours a day do you anticipate your dog will be home alone?*

Spouse or Significant Other.*

Co-Applicant (Spouse of Significant Other).*

First NameLast Name

Co-Applicant Date of Birth.*

Date

Co-Applicant/Spouse/Significant Other E-mail:*

example@expample.com

Co-Applicant/Spouse/Significant Other Home/Cell Number:*

Area Code + Phone Number

Co-Applicant/Spouse/Significant Other's Employer:*

Co Applicant/Spouse/Significant Other's hours worked per day.*

Are there children in the home?*

Do you have other children that do not live at home but visit? *

Additional Residents other than those listed above.*

Please list names and birthdates of additional residents:

How often do you have visitors*

Does anyone in the home have pet allergies*

PUPPY PLAN: When adopting a puppy less than 8 months old, we require a PUPPY PLAN. If you are not applying for a puppy, please disregard this section.

How will you provide potty breaks for your puppy?

How long in between potty breaks?

How will you potty train?

Will you be attending puppy classes?

YesNo

Will you be attending obedience classes?

YesNo

Have you ever raised a puppy before?

YesNo

How will you socialize your puppy?

Where will your puppy sleep?

Where will your dog be when you are not home?*

YOUR CAR AND HOME

Year/Make/Model of your car:*

Type of living space:*

ApartmentHouseCondo

Rent or Own?*

RentOwnOwned by Relative

If you rent or home is owned by a relative, please provide name and telephone number of landlord or owner:*

NameTelephone number

Number of years at residence:*

Address of previous residence.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you plan on moving in the next 12 months?*

YesNoUnsure

If you move, will your dog(s) go with you?*

YesNo

Area description:*

RuralUrbanSuburban

Is your yard fully fenced?*

YesNoNot Applicable

If your yard is fenced, please describe the fence:*

Does your municipality have a limitation on the number of dogs you can own?*

YesNoNot Sure

Does your municipality have any Breed Specific Legislation enacted?*

YesNoNot Sure

If yes to Breed Specific Legislation, please list the breeds.

YOUR ANIMALS

Please know that to be approved for adoption from CLE Dog Rescue Crew, any cats and dogs in your care must be spayed or neutered. We will validate all information with your veterinarian.

How many dogs do you own?*

Dog 1 - Name

Dog 1 - Breed

Dog 1 - Sex

MaleFemale

Dog 1 - Age

Dog 1 - Spayed/Neutered?

YesNo

Dog 1 - Up to date on vaccinations including rabies?

YesNo

Dog 1 - Brand of heartworm prevention used.*

You must buy this from the vet or with a prescription.

Dog 1 - Where was heartworm prevention purchased?*

Dog 1 - Date of last purchase.*

Date

Dog 1 - Brand of flea/tick prevention used.*

Dog 1 - Where was flea/tick prevention purchased?*

Dog 1 - Date of last purchase.*

Date

Dog 1 - Brand of food.*

Dog 1 - Indoor or outdoor?*

IndoorOutdoor

Dog 1 - Please describe personality?*

At what age did Dog 1 join your family?*