Please take some time to fill out this form as completely as you are able to give us an idea of the home you would provide for a dog from our rescue.
Please answer the questions truthfully, there are no right or wrong answers - just honest ones.
| Date: | |
|---|---|
| Name: | |
| Date of Birth: | |
| Occupation: | |
| Spouse's Name: | |
| Spouse's Date of Birth: | |
| Spouse's Occupation: | |
| Do you have children? | No Yes |
| If yes, how many? | |
| Street Address: | |
| City: | |
| State: | |
| Zipcode: | |
| Do you own your home? | No Yes |
| If no, do you have permission from your landlord? | No Yes |
| How long have you lived at this address? | |
| Phone Number: | |
| Email Address: |
| When were you looking to adopt? |
Now
A few weeks A few months No rush |
|---|---|
| How old of a dog are you interested in? | Puppy Adult Either |
| Is there a certain dog on our site that you were interested in? | |
| Please rate the following as most to least important. 1 = most important, 5 = least important. |
|
| Good with other dogs: | |
| Good with cats: | |
| Good with kids: | |
| Low energy: | |
| Good watch dog: | |
| Have you owned other pets? | No Yes |
| Please list the number of pets you currently own. | |
| Dogs | |
| Cats | |
| If any current pets, please provide name, address and phone of your vet clinic. | |
| Have you applied to this rescue before? | No Yes |
| Have you applied to another rescue before? | No Yes |
| If another rescue, which one? |
| If you have no current pets, please list the vet clinic that you will be taking your new dog. | |
|---|---|
| How are you planning to exercise your new dog? | |
| How often are you planning to exercise your new dog? | |
| Are you planning to take your new dog to some behavior classes? | No Yes |
| How much time can you devote per day to your new dog? | |
| How long do you plan to work with your new dog until he / she gets situated into your new household? | |
| How much to you anticipate on spending per year on your new dog for vet bills? | |
| How much to you anticipate on spending per month on her / his food? | |
| How much to you anticipate on spending on supplies such as bowls, leash, collar, treats & toys? | |
| What is the longest period of time that you intend to leave your dog outside unattended? | |
| What is the longest period of time that you intend to leave your dog inside unattended? | |
| Do you have a crate or room set up for confinement inside? | |
| Have you or any member of your household been prosecuted for animal cruelty? | No Yes |
| Do you have a fenced in yard? | No Yes |
| Where will your new dog be kept during the day? | |
| Where will your new dog be kept overnight? | |
| Does your neighborhood have any breed restrictions? | |
| Does your home owner's insurance have any breed restrictions? |
| Please list 1 reference that we may call of a person who has known you for more than 2 years that is NOT related to you. | |
|---|---|
| Please list 1 reference that we may call of a relative of yours. | |
| Please make sure all information is complete before submitting... |
