Tobytimeanimalfoundation@yahoo.com
NAME
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Address
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City
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State
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Zip code
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Email
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example@example.com
Primary Phone
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Alternate Phone
Birth date
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Month
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Day
Year
Date
Place of Employment
*
Please provide 2 non-family references (name and phone number)
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Name of the dog that you are interested in
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Do you currently own or rent?
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How long have you lived in your residence?
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Landlords Name
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Phone #
How many adults live in your home?
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How many children, if any, and ages?
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Who would be primary caretaker of dog?
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Does anyone in your household have allergies?
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How many hours will the dog be alone each day?
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Where will the dog be kept when no one is home?
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Where will the dog be kept at night?
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Do you have a fenced in yard? If so, how high is it?
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Please list all pets you’ve owned in past 5 years and if you no longer have them, why?
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If you have other pets are their vaccinations current?
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Name of current/past veterinarians used
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Phone #
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Under what circumstances would you not keep this dog?
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Please describe activity level and temperament you’re looking for in a dog
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The noise/activity in my home is usually
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My ideal dog would
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Bad dog habits that I cannot tolerate are
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What are your plans for training the dog?
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Printed Name
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Date
*
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Month
/
Day
Year
Date
Signature
*
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