Form

Name*

Co-Applicants Name:

Email address*

(NO work email, personal address only. This is the email address we use to stay in contact you.)

Address:*

City*

State*

Zip Code*

Home Phone:*

Alt. Phone:

Employer:

Name & Phone Number of Person Reference 1:

Name & Phone Number of Person Reference 2:

Own or Lease Your Home:*

Do you live in an apartment, duplex, residential home, etc.?*

How long have you lived at your current residence?*

If you lease, do you have a letter or lease stating you are allowed to have pets?

If you have children at home, what are their ages?

Is everyone in your home in agreement to adopt a Animal?*

Yes No

Where will your pet sleep at night?*

Where will your new dog stay when no one is home?*

Are you willing to purchase a crate and use it for your new dog?*

Do you have a fenced yard? (If you do not live in an apartment, a fence is REQUIRED.)*

Yes No

If so, what type of fence do you have and how tall is it?

Check one that fits you.*

I\'m active and love to be outdoors I enjoy reading, computer games and watching TV/Movies I would love to have a Animal I can take to the park every I\'m more into taking walks around the neighborhood I would rather spend my time playing with my dog in my yard I\'m looking for an easy dog that just wants to be my companion

Which Animal(s) are you interested in adopting?

Tell us what makes this Animal a great match for you or your family?

List your Current Pets List all animal(s) by NAME, SEX and AGE that are currently in your care.

Are all of these pets current on vaccinations, neutered and on monthly heartworm preventative?

no Yes

What other animals have you had in the past FIVE years and what happened to them. Please be specific. Died/How, Ran Away/How, etc.(Do NOT include pets you had as a child.)

Under what circumstances would you NOT commit to keeping the dog you adopted?*

Name of Vet Clinic:*

Address:*

Phone Number:*

Do you have any comments that would like to share or that may help us in approving your application?

Information

Veterinary References