Dog Application
Primary Adopter First Name
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Primary Adopter Last Name
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What is your street address?
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What is your city?
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What is your state
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What is your zip code?
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Phone Number
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Email
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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.
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How busy is your family schedule
Very Busy
Busy
Not Busy
Any Allergies in the family?
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No
Yes
Where will your dog stay during vacation/traveling?
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Do you rent or own your property?
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If you rent or are on land contract, it is your resposibility to obtain permission before adopting.
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No
Yes
Who is your Landlord?
What is your landlord phone number?
Where will your new dog be kept during the day?
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Where will your new dog be kept at night?
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Where will your new pet be kept while not at home?
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Please provide the name, address, and phone number of your primary care veterinarian.
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Do you agree to provide any and all veterinary treatment that my new pet may require throughout his/her lifetime?
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No
Yes
Are you aware of the need for heartworm prevention?
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No
Yes
Are you financially prepared to provide the care and commitment?
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No
Yes
Are your pets current on their Rabies vaccination?
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No
Yes
Are your pets spayed or neutered?
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No
Yes
What will you do with your new dog if you move? *
*
Do you have a fenced yard or dog run?
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No
Yes
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?
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Select the Dog
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Avril (Dog - 25D-05093)
Bud (Dog - 24D-11267)
Diamond (Dog - 25D-03057)
Drago (Dog - 25D-03053)
Grey (Dog - 25D-05103)
Lennon (Dog - 25D-03052)
Mellie (Dog - 25D-02040)
Milo (Dog - 25D-04062)
Moose (Dog - 25D-03059)
Nugget (Dog - 24D-12088)
Princess Peach (Dog - 25D-02042)
Shane (Dog - 25D-05003)
Twiggs (Dog - 25D-06106)
Wade (Dog - 25D-05001)
Type the dog name(s) of others interested in
Have you ever brought an animal to our shelter or to any other shelter?
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No
Yes
How did you hear about us/this dog?
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