Online Application

First Name* Last Name* Email* Home Phone Street* City* Postal Code* State* select state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Guam Puerto Rico Employer Name*

Please tell us what dog(s) you might be interested in.* Have you ever owned a dog? If so, do you still have it? If not, what happened?* Have you ever surrendered a dog to a shelter?* Yes No Have you ever bred a dog?* Yes No Have you ever sold or given a dog away?* Yes No Have you ever had a dog run away or be poisoned?* Yes No Have you ever had a dog hit or killed by a car?* Yes No Have you ever had a dog die from disease?* Yes No If You Answered 'Yes' to Any of these Questions, Please Explain Are you familiar with heartworm preventitive medication?* Yes No

What other pets in the home?* Have all household pets been spayed or neutered?* Yes No If cats, do they have claws?* Yes No Do You Own Your Own Home?* Yes No Do you rent a home, apartment, condo, or townhouse?* I rent a home I rent an apartment I rent a condo I rent a townhouse I do not rent If you rent, is your landlord in agreement with your intention to adopt a dog?* Yes No Where you reside, is there a yard?* Yes No If there is a yard, is it fenced?* Yes No Does the gate lock securely?* Yes No If you don't have a fence w/ gate, would you install one?* Yes No

Where will this dog be exercised?* How many times a day will you walk the dog?* Do you envision this dog being allowed to run free?* Yes No Please describe how much time this dog will be outside.* Will this dog be tied up outside?* Yes No Do you intend to crate train this dog?* Yes No Maybe Do you have experience with crate training?* Yes No Are you willing and financially able to go to obedience classes or hire a trainer?* Yes No Have you used dog trainers in the past?* Yes No Do all adults in the home work full time? What hours?* Please estimate the approximate time the dog would be left home alone daily.* Would this dog primarily be kept indoors or outdoors?* Outdoors Indoors Where will the dog sleep at night?* Will your dog have the run of the house?* Yes No Will this dog be crated inside, if so when?* If your dog has or develops behavioral issues, please tell us how you would address the issue(s)?* How often and for how long do you travel?* What have you done in the past, or plan to do, with your dog when you travel?*

Sex:* Male Female Either Age:* Activity Level:* Please explain what level suits you and your family's needs and why.* Please take into consideration some dogs grow substantially larger than others. If this is a concern to you please let us know what size is best for your family.* Are you aware that a larger dog has the capacity to knock down a small child or an older/frail individual?* Yes No Are you willing to travel to pick up your dog? If yes, how far would you go?* The finanical responsibility of caring for a dog is estimated between $700 and $800 per year with considerations to vet fees for inoculations, general vet care, good quality food, licenses, grooming, etc. Are you prepared for this financial undertaking?* Yes No Are you aware that the higher grade dog foods such as Eukanuba, Nutro, California Natural, etc will be more money to purchase but be a much healthier choice for your new family member?* Yes No Do you have plans to relocate in the near future? If yes, what would you do with this dog?* In your best judgement, what would justify getting rid of a dog?* Do you fully understand and respect that our dogs are NEVER to be sold, given away or left at an animal shelter?* Yes No Are you familiar with your community's leash laws, and the laws regarding rabies?* Yes No Have you ever given an animal as a gift?* Yes No Do you understand that we request a volunteer does a home visit to meet you and your family?* Yes No We also request your prior or current Veterinary Care's name, address and phone number, which is standard procedure with adopting from a rescue organization.* Do you realize that it will take time for your new dog to adjust to its new home, especially if you have other pets: (usually 2-4 weeks, sometimes longer). They may require extra attention and exercise during this period or fewer visitors to your home at first. Are you willing to make adjustment to your daily routine during the adjustment period?* Yes No

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 dog. For example, some people enjoy camping or running with ther dogs....IT IS IMPORTANT TO US THAT THIS BE COMPLETED!!* Please list the names and ages of all persons residing in the home. Family/Age Member 2 Family/Age Member 3 Family/Age Member 4 Family/Age Member 5