Dog Adoption Application

Thank you for your decision to adopt a rescued dog/puppy. You are encouraged to look at all the available dogs to find one that is best suited for your lifestyle. You must be 18 years or older to fill out this application. Our dog coordinator will review your application thoroughly. Please allow 3 to 5 business days for us to review your application. Decisions could take up to a week. Response times will vary, and we appreciate your patience during this time.

Are you interested in adopting more than one dog? *
Name of dog/puppy you are interested in adopting
Name of the other dog/puppy you are interested in
If the dog isn't listed, please enter the name here:
First Name *
Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Home Phone * If your cell phone is your only phone number, please put it here.
Cell Phone
Work Phone
Email Address *
Are you 18 or older? *
Employer *
To ensure that this adoption is in the best interest of both you and the dog, please answer the following:
Local Reference * Please list the name of a local reference not living with you.
Phone number for local reference: *
Do you rent? *
Complex or Landlord's Name *
Length at this address: *
Landlord's Phone Number *
Including yourself, how many people live in your household? *
Are there children under 18 in the home? *
Please list genders and ages of each child under 18 in the home: *
Are there animals living in the home? *
Please list names, ages, and breeds/species of all animals in home: *
Are your current pets spayed/neutered? *
Explain why current pets aren't spayed/neutered: *
Veterinarian's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Phone Number
Are you prepared to take on the financial responsibility including veterinary care upon adoption? *
Do you agree to provide needed vet care & heartworm preventative for your dog? *
What happens to the dog if you move? *
What happens when you vacation or have to leave town? *
How many hours a day will dog be left alone? *
Where will the dog be kept? *	Inside Outside Both
Where will dog be in the daytime? *
Where will dog be at night? *
Please provide a brief description of this pet's living conditions. *
Do you have a completely fenced-in yard? If so, what kind of fence? *
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out? *
Are you willing to work with the dog should behavior problems arise & seek help to solve problems if needed? *
I have read the application carefully and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. I am also aware that this is an adoption application, and my application may not be selected. *