Dog Application

Primary Adopter First Name *

Primary Adopter Last Name *

What is your street address? *

What is your city? *

What is your state *

What is your zip code? *

Phone Number *

Email *

Confirm email

DL/ID Number

Date Of Birth

Who are you adopting this for?

Myself

Other

Please list names and ages (Jane Doe/25 yrs.) of all other parties living in the home. *

How busy is your family schedule

Very Busy

Busy

Not Busy

Any Allergies in the family? *

Where will your dog stay during vacation/traveling? *

Do you rent or own your property? *

If you rent or are on land contract, it is your resposibility to obtain permission before adopting. *

Who is your Landlord?

What is your landlord phone number?

Where will your new dog be kept during the day? *

Where will your new dog be kept at night? *

Where will your new pet be kept while not at home? *

Please provide the name, address, and phone number of your primary care veterinarian. *

Do you agree to provide any and all veterinary treatment that my new pet may require throughout his/her lifetime? *

Are you aware of the need for heartworm prevention? *

Are you financially prepared to provide the care and commitment? *

Are your pets current on their Rabies vaccination? *

Are your pets spayed or neutered? *

What will you do with your new dog if you move? * *

Do you have a fenced yard or dog run? *

Upon application you agree to a home visit that helps to ensure us that the pet is in a safe and happy environment. What time of day works best for you? *

Select the Dog *

Type the dog name(s) of others interested in

Have you ever brought an animal to our shelter or to any other shelter? *

How did you hear about us/this dog? *