Dog/Puppy Application

This form is an application for an NCHS dog or puppy. You must be 18 or over to complete this form.

Are you over 18? If not, please do not continue. You must be over 18 to foster or adopt. * You must be 18 or over to complete this form.
First Name *
Last Name *
Date of Birth *
Street Address *
Address line 2
City *
Zip Code *
Email Address *
State *
Phone Number *
Are you interested in fostering or adopting? *	Fostering Adopting
*	By checking this box, I acknowledge an NCHS representative will need to visit my home prior to fostering or adopting a dog.
	For fosters only: I am willing to bring my foster dog to adoption events at least once a month.
Are you interested in a specific dog? *
If yes, enter the name of the dog/puppy you are interested in
If no, please tell us what size and age of dog you are looking for.	Any size or age Small (1-20 pounds) Medium (20-50 pounds) Large 50-75 pounds) Extra Large (Over 75 pounds) Puppy (0-1 years old) Teen (2-4 years old) Adult (5-7 years old) Senior (Over 7 years old)
Have you ever adopted or fostered a pet from NCHS or another rescue organization? *
Do you have any questions about the dog you chose?
Where will this dog live? *
How many hours each day will the dog be without human companionship? *
Where will this dog stay when left home alone? *
Where will this dog sleep at night? *
Will you be able to keep this dog on monthly heartworm, flea and tick preventatives? For fosters, these will be provided by NCHS. *
Are there any children that live with you or visit your home often? *
Do you currently have pets in your home? If yes, what breed, sex and age are they? *
Are all of your pets spayed/neutered and current on vaccines?
Please list the name, phone number, and location of your veterinarian.
If you have owned pets in the past that you no longer have, please tell us what happened to each of them:
How will this dog be cared for when you leave town? *
What behaviors are you NOT willing to tolerate from a pet? *
What is your housing situation? *
If living in a Apt/Townhouse/Condo, please list the name and phone number of the Manager so that NCHS may speak with her/him about bringing a pet into the complex
How busy is the street in which the home is located? *
What is the size of your yard? *
If your yard is fenced, what type of fence is it? Please list size and material. What type of fence do you have (list material)? *