Dog Adoption Application

Hidden
Default: Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country*
Home Phone Number
Work Phone Number
Cell Phone Number*
- Preferred Method of Contact
- How Did You Hear About Us?*
- What Is Your Friend's Name?*
- Which Shelter?*
- Which Rescue?*
- Please Describe*

Name	Age	Previous Experience with Dogs:	Actions

There are no Children.

Pet's Name	Animal Type	Sleeping Quarters	Actions

There are no Pets.

Residence
- Type of Residence*
- Please Describe Type of Residence*
- Do You Own or Rent?*
- Does Landlord Allow Dogs?*
  - Yes
  - No
- Are There Any Breed Or Size Restrictions?*
- Please Provide Landlord's Name*
- Please Provide Landlord's Phone Number*
- Who is your homeowners or renters insurance provider?*
Yard Information
Do You Have A Yard?*
- Yes
- No
Is The Yard Fenced?*
- Yes
- No
How High Is The Fence?*
What Is The Lowest Point of The Fence?*
What Material Is The Fence Made From?*
Please Describe Fence Material*

Family & History
- What Type Of Household Do You Have?*
- Please Describe*
Sleep & Alone Time
- Where Will The Dog Sleep?*
- Where Will The Dog Be When Alone?*
- Please Describe Where The Dog Will Be*
- What Is The Longest Time The Dog Will Be Alone (without humans)?*
Behavior & Training
Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Dog Comfortable In Your Home?*
- Yes
- No
What Behaviors Can You Tolerate (and work on)?
Needs Social Skills*
Accidents In The House*
Inappropriate Chewing*
Excessive Barking*
Separation Anxiety*
Digging*
- Other
  - can tolerate and will train
  - No
- Please Explain Other Behaviors You Cannot Tolerate*
- What Are Your Plans For Training Your New Dog?*
- Please Describe Your Training Plans*
Personal Reference
Please Provide A Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Please Provide Reference's eMail Address*
Relationship to Applicant*
Years Acquainted
Personal Reference
Please Provide A Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Please Provide Reference's eMail Address*
Relationship to Applicant*
Years Acquainted
Personal Reference
Please Provide A Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Please Provide Reference's eMail Address*
Relationship to Applicant*
Years Acquainted
Veterinarian Information
Have You Used A Veterinarian Before?*
- Yes
- No
Please Provide Veterinarian's Name*
Please Provide Veterinarian's Phone Number*
Length of Relationship*

Would You Consider:
Do You Have A Preferred Dog?
Note: This does not guarantee this dog will be placed with you
Explain your interest in this dog
Explain your interest in this breed
What are your thoughts on Spay/Neuter?
NOTES
Is There Anything Else You Would Like to Let Us Know?
Authorization
Authorization:*
I have read the Adoption Process, Policies and FAQ on the website. I certify that the information entered on this application is true.
- I agree
Phone
This field is for validation purposes and should be left unchanged.

Dog's Name	How Long Did You Own Him/Her?	Where Did You Get The Dog?	Gender	Actions

There are no Dogs.

Adoption

Residence

Yard Information

Family & History

Sleep & Alone Time

Behavior & Training

What Behaviors Can You Tolerate (and work on)?

Personal Reference

Please Provide A Personal Reference

Personal Reference

Please Provide A Personal Reference

Personal Reference

Please Provide A Personal Reference

Veterinarian Information

Would You Consider:

NOTES

Authorization

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First Name	Last Name	Age Range	Relationship To Applicant	Actions

There are no Adults.