Application to Adopt

Adopter's Name *
Adopter's Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Name of Dog of your interest
Residence *
Residence
If you are renting does the landlord allow pets?
If you are renting does the landlord allow pets?
Please provide the name and contact number for the management for verification
Number of adults (18+) in the household
Number of children (under the age of 18) in the household
Ages of children
Are any of the household members allergic to dogs?
Are any of the household members allergic to dogs?
In the event of an emergency, what is the estimated vet bill you can afford?
Type of fence
Height of fence
The dogs will stay
The dogs will stay
Have you owned a pet before?
Have you owned a pet before?
If answered "YES" above and no longer have the pet, please explain what happened. If you answered "Yes" above and currently own a pet, please state type/breed and age of pet.
Do you have any other pets? *
Do you have any other pets?
Other type of pet:
If the other pet is a "Dog", is it spayed/neutered?
If the other pet is a "Dog", is it spayed/neutered?
If you answered "No" above, please explain why.
Do you have a primary vet? *
Do you have a primary vet?
If answered "Yes" above, please provide name and address.
May we contact them?
May we contact them?
If you answered "No" that you don't have a primary vet, please explain
Where will the dog sleep?
How long will the dog be left alone in a regular day?
What kind of experience do you have with dogs and breeds?
What other factors you feel should be considered?
How did you hear about us?
How did you hear about us?
Would you like to receive newsletters and future updates from the rescue? *
Would you like to receive newsletters and future updates from the rescue?
Today's Date *
Today's Date