Dog Adoption Application

Name of the dog you want to adopt*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Names and ages of all permanent residents of your home (adults/children)*
Current pets in your home: Species, Breed, Name, Age, Sex, Altered yes or no?
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Is anyone in your home allergic to dogs?*

YesNo
Does anyone in your home fear dogs?*

YesNo
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeApartment
Do you rent or own this property?*

RentOwn
If you rent, you must obtain permission from your landlord or provide a copy of the section of your lease stating that you are allowed to have pets and showing any limitations.
Name of Landlord
Landlord Phone Number
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
How many hours per day will this dog be alone? Explain*
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain.*
What activity level do you prefer?

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this dog...*

As a family petTo train/use for huntingTo train/use as a therapy dogTo train/use as an assistance dog for the disabledFor a jogging/hiking partnerAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted dog will...

Be crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenBe boarded when we go on vacationStay with family when we go on vacationOther
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return a dog?*
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
How do you plan to integrate this dog into your family?*
How long have you been looking for a dog?*
Reference #1
Name*
Phone Number*
Email
Relationship*
Reference #2
Name*
Phone Number*
Email
Relationship*
Reference #3
Name*
Phone Number*
Email
Relationship*
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*
Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.
Applicant's Signature*
Co-Applicant's Signature
Signature date*
Should be Empty:

Reference #1

Reference #2

Reference #3