Online Adoption Application

Date

PERSONAL INFORMATION REGARDING: YOU, YOUR SPOUSE, YOUR CHILDREN, AND "REGULAR' VISITORS...

About You!

Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

E-mail*

Work Phone

Occupation

How long employed?

Current Employer

How long employed

If unemployed, whose income will be supporting this animal?

Your Spouse

Spouse Name

First NameLast Name

Email

example@example.com

Occupation

Current employer

How long employed

Your Children/Stepchildren that live with you on a full-time basis:

Name

First NameLast Name

Age

Name

First NameLast Name

Age

Your Children/Stepchildren that live with you on a part-time (i.e. weekends) time basis:

Name

First NameLast Name

Age

Any other individuals that may spend a significant amount of time at your home

If you have children, have your children been around different breeds of dogs?

YESNO

How are the children around dogs?

Are there children in your household who could open a door and inadvertently let the dog out?

YESNO

Are you willing to teach your child to accept the additional reasonable care and treatment of a dog?

YESNO

Do neighborhood children use your yard as a short cut to a local school or hang out?

YESNO

Are your children and the children in your life mature enough to be around dogs?

YESNO

Would your children be responsible for exercising the dog?

YESNO

Would your children b responsible for feeding or grooming the dog?

YESNO

Would your children be responsible for training the dog?

YESNO

How much, if any, of the dog's care would be entrusted in your children?

ALLMOSTSOMENONE

Do they understand that you are in the process of adopting a large or extra large dog?

YESNON/A

Has you or anyone in your immediate family/household ever been convicted of a charge related to cruelty to animals or child abuse?

YESNO

Is there any such charge pending?

YESNO

Has any such charge been filed?

Type option 1Type option 2Type option 3Type option 4

If yes to any of the above, please explain and give disposition of charge.

Please tell us a brief history about your family, children, house, yard, and pets you have or have had.

Where have you looked for a new pet?

How do you feel about the above groups?

Does anyone in the family not like big dogs (over 70 lbs - 200 lbs)?

YESNO

Which family member would be the main caretaker of this animal?

Have you had or fostered a dog before?

YESNO

If yes, what kind of dogs?

EXISTING/PREVIOUS ANIMALS IN HOUSEHOLD

Where did you get your current pets?

How old were the pets when you got them?

CURRENTLY OWN

Tell us about the pets you currently own, including Type, Age, Neutered/Spayed,Current on vaccines, Indoors/Outdoors.

PREVIOUSLY OWNED

Tell us about the pets you have previously owned including Type, Age, Neutered/Spayed, Current on vaccines, Indoors/Outdoors.

HOME ENVIRONMENT

Where will you dog be when you are at work or away for other reasons?

Where will your dog sleep?

What type of home do you live in?

Do you own or rent?

RentOwn

Would your neighbors complain if you had a large or extra large dog?

YESNO

Do you have a fenced in yard?

YESNO

If yes, how large?

What kind of fencing?

How high is it?

Have you repaired any openings along the bottom of the fence where small dogs can escape?

If you do not have a fenced in yard:

How will you exercise the dog and how will you provide his need to eliminate?

What is the maximum number of hours your dog will be left alone in a 24 hour period?

Where will he spend his time?

Do you object to the idea of a crate?

YESNO

Do you have a crate?

YESNO

Would you get one?

YESNO

What would you do if your dog was destructive when left alone?

Are you willing to attend obedience classes with your dog?

YESNO

Have you ever surrendered a pet to an animal shelter?

NOYES

If yes, under what circumstances?

Have you ever sold or given away a pet?

YESNO

If yes, why?

Have you ever trained a dog before?

YESNO

If yes, why?

VETERINARY/HEALTH CARE INFORMATION

Current vet and phone number for vet reference check:

Would you be willling to continue to use the vet the dog has been seeing?

YESNO

Do you have the financial capability to purchase this dog's special needs medicine (if needed)?

YESNO

Do you provide heartworm prevention, annual vaccines and other necessary vet care for your pets?

YES to allNo to allYes to annual vaccines, but no heartwormNo, I do not believe in giving animals chemicals

Can you afford to spend at least $500/year for food and routine medical care for your pet?

YESNO

Do you, yourself, provide any vaccinations to your pets?

YESNO

If so, what type?

DistemperParvovirusLeptospirosisOther

Are you aware of your responsibilities to license your pet, respect the local leash laws and poop-n-scoop laws?

YESNO

What breed are you looking for?

Have you owned this breed before?

YESNO

Have you educated yourself about this breed of dog?

YESNO

Please list your preference regarding:

Sex of dog

MaleFemaleEither

Will you consider something other than your stated preference?

YESNO

First Choice of your breed of dog

Second choice of your breed of dog

Third choice of your breed of dog

Are you willing to pay to ship a rescue dog?

YESNO

How far, in miles, can you drive to look at/pick up a dog

Please provide the names and phone numbers of two non-related individuals who can serve as references

What are the requirements for dog ownership in your community?

How many pets may you legally have?

Are dogs required to be vaccinated against rabies

YESNO

Is there a leash law?

YESNO

What kind of dog food will you feed? Be specific please.

What hobbies do you have in which you could include your dog?

What circumstances, in your mind, justify getting rid of a dog.

What would you do with the dog if the above circumstances occurred?

IF FOR ANY REASON YOU WOULD HAVE TO FIND A HOME FOR THIS DOG DUE TO MEDICAL OR OTHER REASONS, THE UNDERSIGNED WOULD BE CONTACTED FIRST TO TAKE SAID DOG BACK. IF FOR ANY REASON THE DOG WOULD REQUIRE MEDICAL TREATMENT THAT YOU COULD NOT AFFORD RATHER THAN PUTTING HIM DOWN, YOU WOULD CONTACT THE UNDERSIGNED FIRST.

This is a written contract signed between two consenting parties.

Thank you for taking your time to complete this application.

Please verify that you are human*