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 you're away? *
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? * *
List of Current Pets
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? *