What is the Name of the Dog(s) you are applying to adopt?
If the dog that you are applying for finds his/her forever home prior to you meeting him, would you like us to contact you about similar dogs at our rescue?
Place of Employment
Type of Home (House, apartment, condo, townhome or other)
Condo/Townhouse without Yard
Condo/Townhouse with Yard
House without Yard
House with Yard
Do you rent or own your home?
If you rent, are pets allowed?
Landlord’s name, if applicable
Landlord’s phone number, if applicable
How long have you been at your current residence?
Under a year
Do you plan to move within a year and if so, where?
What will you do with your dog if you move?
If you are to become unable to care for this animal due to health, death or any other reason, do you have a plan for where the animal will be placed? (For example “I have discussed with my brother that if anything were to happen to me, he would adopt my dogs”)
Please list name, age and relationship of other people living in your home
Why are you looking for a new companion animal?
Who will be the primary caregiver of this animal?
If you have previously owned any animals, what kind of animals did you own and for how long?
If you no longer own animals, tell us why.
Have you ever surrendered a pet for any reason? If so, what was the reason?
Please provide the following information for each companion animal living in your home: Name, Age, Sex, Breed, Spayed/Neutered, Up to date on Rabies and Heartworm Vaccinations?
Veterinarian Phone Number
*Please be aware that we may contact your vet for a reference
Are you aware that the average cost of owning a dog for one year is $750 and may exceed this?
Where will this pet sleep at night?
Are you committed to providing this pet with the necessary medical care and obedience training to ensure his/her well-being in your home for his/her lifetime?
On average, how many hours per day will this animal be left alone in your home?
Where will this animal be kept when unsupervised?
Do you have a fenced yard? If yes, how high and what type of fence is it? Will animal ever be left unsupervised in yard or anywhere else outdoors?
How will this animal get exercise?
Under what circumstances would you surrender this animal?
Is there anything else that you would like to tell us?