Dog Adoption App

Dog Adoption Application
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number

Area CodePhone Number
Are you 18 years of age or older?*

YesNo
Birth Date*

MonthDayYear
Do you own your own home?*

YesNo
If no, name and phone # of landlord:
Type of Dwelling:*
Name and age of ALL occupants in household (including yourself):*
How many total hours will your new pet be left alone during the day?*
What is your day to day routine like?*
Do you have a fenced yard?*

YesNo
If yes, which type of fence?*

WoodChain LinkN/AOther
If yes, how tall is your fence?:*
Please list other animals in your home, including breed and age.
If you currently own a dog or cat, how does he/she react to new pets?
Are your current pets up-to-date on their annual vaccines?*

YesNoN/A
Are your current pets spayed or neutered?*

YesNoN/A
If no, please explain.
Which dog(s) are you interested in adopting?*
Can/Will you provide your dog with monthly heart worm/flea/tick prevention?*

YesNo
Who is your current or most recent veterinarian? Please provide their business NAME and PHONE NUMBER:*
Where will your dog spend most of his/her time?*
Please provide a personal reference that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.
Reference #1*
First and Last Name & Relationship to Self
Reference # 1 Phone Number*

Area CodePhone Number
If there is anything else you think we should know, please note it here.
Thank you so much for wanting to rescue a dog!!
Should be Empty:

Dog Adoption Application

Please provide a personal reference that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.

Thank you so much for wanting to rescue a dog!!