Canine Wait List

This form is not an application. You will need to fill one out later if we have a dog that is suited to your needs.

What type of dog are you interested in? (Species, name)

Reason you want a dog

Please Provide More Information on why you want a dog through our organization

Your name

First & Last Name

Your Address

Street Address

Street Address Line 2

CityState

Zip Code

Your Email

Your Phone Number

Area CodePhone Number

Phone Type

Names and ages of all permanent residents of your home (adults/children)

Please list any pets currently living in your home, and if they are vaccinated and altered.

How long will the dog be left alone during the day? Describle your work schedule and employment

Have your current or previous dogs been on heartworm prevention? This will be verified through vet records at a later time

Are you planning to move in the near future?

If moving soon, to what city/state?

When will you be ready to adopt this animal?

Is anyone in your home allergic to the animal you're planning to adopt?

Are you familiar with the breed?

You live in a:

Do you rent or own this property?

If you rent, you must give the person you are adopting from a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have this type of animal and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have this type of animal there and show any restrictions.

Do you have a yard?

Have you discussed this adoption with all members of your household?

Do you have any additional comments, questions or concerns?

By checking the box below, you understand that a background check will be conducted.

Signature

Signature date

Thank you for taking the time to submit this form. We do receive many requests. If we have a suitable dog we will be in contact.