Your name (first & last) :*
Spouse or significant other's name (first & last) :*
Email addresses :*
Home phone numbers :*
Cell phone numbers :*
Work phone numbers :
Address, city, state, zip :*
How many people reside in your home? What are their ages? :*
Your employer: :*
Your spouse/significant other's employer: :*
What is everyone's work schedule? How many hours is everyone usually gone per day? :*
Do you live in a home, apartment, condo or manufactured home? :*
How long have you resided at this address? :*
Do you own or rent? :*
If you rent, does your rental agreement allow you to have a pet? :
Does anyone in your family have allergies to pets? :*
What is your household activity level? Active/Moderate/Quiet :*
Current veterinarian name and phone number. May we contact them for more information? :*
Current pet groomer name and phone number. May we contact them for more information? :*
Are you interested in a specific dog from our web site? If yes, name of dog? :*
If not interested in a specific dog, what kind of dog are you looking for? Breed, sex, age, color :*
How soon are you ready to adopt? :*
If your adopted dog chews, digs or has any bad habits, what will you do? :*
Under what circumstances would you consider giving away your dog to a new owner? :*
Who will be responsible for the care and feeding of your adopted dog? :*
What brand of dog food do you plan on feeding your adopted dog? :*
What arrangements will you make for your adopted dog when you travel? :*
Do you have any upcoming travel plans? If yes, when and for how long? :*
Please describe your front yard and back yard, including approximate size, patios, landscaping. :*
Please describe the fencing in your front and back yard, including type and height: :*
Do you have a pool? If yes, how will you safeguard your dog from drowning? :*
Where will your dog be kept while you are gone? :*
Where will your dog be kept while you are home? :*
Where will your dog sleep? :*
Where are your water, gas and electric meters located? :*
Do you have a gardener or other person that enters your yard? How will you safeguard your dog? :*
How do you plan on housetraining your new dog? :*
Tell us about current and previous dogs you have had: :*
Is there any other information that may be helpful for us to know? :*
Have you been approved by any other rescues? Their name? :*
Please type the text below :
