Name
*
First Name
Last Name
Age (applicant must be at least 25 years of age)
Email Address
*
Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Co-Applicant
First Name
Last Name
Co-Applicant Age
Co-Applicant Email
Co-Applicant phone
(###)
###
####
Employer- Applicant
Employer: Co-Applicant
Relationship to Applicant
Other members of the household (names and ages)
Please tell us what dog you might be interested in.
Have you ever owned a dog as an adult?
*
yes
no
If "yes" do you still have it? If "no" please tell us what happened.
Have you ever sold, given away, returned a dog or surrendered a dog to a shelter?
*
Yes
No
Have you ever bred a dog?
*
Yes
No
Have you ever had a pet who became lost?
*
Yes
No
Have you ever had a pet treated for a disease?
*
Yes
No
Have you ever had a pet poisoned?
*
Yes
No
Have a ever had a pet killed by a vehicle?
*
Yes
No
If the answer to any of the above is "yes", please explain in detail.
Are you familiar with heartworm preventative?
*
Yes
No
Do you have other pets in the home?
*
Yes
No
Please tell us a bit about the other pets at home.
*
for example - other dogs, cats, spayed, neutured, etc.
What is your experience with rescue dogs?
*
Living situation
*
I own my home
I rent my home
I rent an apartment
I rent a condominium/townhouse
If you rent, is your landlord in agreement with your intent to adopt a dog?
*
Yes
No
I don't rent
Are you planning on moving in the near future?
*
Yes
No
When/if you are moving, what will you do with your dog?
Does everyone in the household want to adopt a dog?
*
Yes
No
Yard
*
No yard
Yard with no fence
Yard with invisible fence
Yard with physical fence/gate
If your yard does not have a fence, would you be willing/able to install one?
*
Yes
No
Please describe your planned exercise routine for your new family member?
*
For example, how often will they be walked, will they be an indoor or outdoor dog, is doggie daycare an option?
If no fence or partial fencing, how will your dog be allowed to exercise, play and relieve himself/herself while being kept from running away, getting lost or getting hurt?
*
Please be as detailed and specific as possible - describe HOW you plan to do this.
Do you have a tie-out or runner for your dog?
Yes
No
If yes, please explain in detail how and when it is used.
Crate training
*
We recommend crate training for all new rescues
I plan on crate training
I have not planned on crate training
I have no experience but am willing to learn
Are you willing and financially able to attend obedience classes and/or hire a trainer?
*
Yes
No
Please describe any prior experience you have had with obedience training in the past.
Do all the adults in the home work full time?
*
Yes
No
How many hours per day would you estimate the dog will be left alone, including commute time, WITHOUT the PRIMARY adult applicant(s)?
What provisions will be made for the dog during those hours?
Have you applied to any other rescue groups?
*
Yes
No
If yes, have you been approved to adopt and what is the name of that rescue?
Dog preference
Male
Female
Age preference
Puppy
Young Dog (1-4 years)
Middle Age (4-8 years)
Senior Dog (8+ years)
Please explain what level of activity suits you and your family.
*
Please take into consideration that some dogs grow substantially larger than others. If this is a concern, please let us know what size is best for your family.
How far would you be willing to travel to pick up your dog?
The financial responsibility of caring for a dog is estimated to be between $800-$1,000 per year for general vet care, innoculations, good quality foods, licenses, grooming, etc. Are you prepared for this financial undertaking?
*
Yes
No
Do you understand that we request a volunteer conduct a home visit to meet with you and your family?
*
Yes
No
It is understood that we reserve the right to remove a dog at any time should we find that the adopter is no longer caring for their rescue dog in a way that we see fit?
*
Yes
No
Local Veterinarian
*
Please provide us with your current veterinarian's contact information. If you have no current veterinarian, please provide us with the name of your planned veterinarian. We would be happy to provide you with a referral if necessary.
Please take this opportunity to tell us other details about yourself, your family, and your lifestyle to further help us make the very best match we can. It is very important you share with us what special interests or hobbies you participate in and what it is you are looking for in a companion.
*
For example, some people enjoy camping or running with their dogs... IT IS IMPORTANT THAT THIS BE COMPLETED.