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First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Please write out your full name and birthdate*
Who else resides in your home? Please give names and ages of all permanent residents of your home (adults/children).
Which dog are you interested in? Choose an animal: Boris Gus Kane Maribel Myk Tessa Zeus
If you currently have pets, please list below (species, age, sex, breed, etc.)*
Are your current pets altered?*
Are your current pets up-to-date on vaccinations?*
If your current pets are not altered, or up-to-date on vaccinations, please explain why.
List at least one reference with phone number (who is not a family member)*
Veterinarian's Name and Phone Number*
Are you familiar with dog regulations in your area?* Choose one: Yes No Not Applicable
If you have had previous pets that no longer are part of the household, please explain what has happened to them.
Does anyone in your home fear dogs?* Choose one: Yes No Not Applicable
Is anyone in your home allergic to dogs?*
Do you own or rent your home?
In what type of home do you live* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing
If you rent, please enter your landlord's name and phone number
If you rent, have you received the approval of your landlord to have an animal? Choose one: Yes No Not Applicable
Do you have a yard?*
Do you work outside the home?* Choose one: Yes No Not Applicable
How many hours will this dog be alone?*
Have you discussed this adoption with all members of the household?
Have you considered the financial impact adopting a dog will add to the household budget? Do you feel you will be prepared for the cost of regular care as well as emergency care ?*
What activity/energy level do you prefer?
Please check all that apply. I want to adopt this dog ...
Please check all that apply. My adopted dog will ...
Please take time to think, be honest with yourself and us when answering this series of questions. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the 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?*
What would cause you to return the adopted dog?*
What would you do if you discovered after adoption (at any time during the life of the dog) your vet diagnosed an expensive health condition?*
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?*
By checking the box below, I confirm I am at least 21 yers of age.
By checking the box below, I confirm that I have answered the questions to the best of my ability and in all honesty. Failure to do so will result in my adoption application being denied.
