Please select from the following:
First Name
Last Name
Email Address
Address and City
State
Zip Code
Home Phone
Work Phone
Cell Phone
Best time to call:
Are you over the age of 21, living independently, and self-supporting?
If you said no to the previous question, please explain:
What is your current profession?
How long have you been employed at your current place of employement?
Why do you want to adopt/foster a dog?
What are the most important responsibilites of caring for a dog?
Does every member of your household want a dog?
Does anyone in your household have allergies?
Have you had pets before?
Describe your previous pets (type, age, sex, spayed/neutered):
Why are these pets no longer with you?
Describe your current pets (type, age, sex):
Are all current pets spayed or neutered?
Are all current pets up to date on vaccinations?
Are all current pets on a monthly heartworm preventative?
Please provide the name, address, and phone number of your previous and current pet's veterinarian(s):
What name are these records listed under?
***Please contact your vet and give permission for them to release your vet records***
Are there any other pets in the home that do not belong to you?
If you answered yes, please provide the name, address, and phone number of those pet's veterinarian(s):
Do you have children under the age of 18? If so, what are their ages?
Please list other residents in your household and their relationship to you:
How long have you lived at your current address?
In which type of home do you live?
If you picked "other," please explain:
Do you own or rent?
If you rent, please provide the name, address and phone number of your landlord:
Do you have a fenced in yard?
If yes, please describe your fence (size, type):
If you do not have a fence, how do you plan to keep your pet at home?
How much time will the dog spend outside?
Where will the dog sleep?
Will someone be home during the day? If not, how long will the pet be left unattended? Where would the dog stay at these times?
What provisions can be made if the pet needs to use the bathroom while left alone?
How frequently will the adults be gone away from home on business or vacations? What arrangements can you make for the dog's care while you're away?
Please describe your feeding plan (type of food, schedule):
Describe your housetraining routine:
Please let us know any age preferences you have in adopting/fostering a dog:
Please list any size preferences you have in adopting/fostering a dog:
Are you willing to accept a dog with special needs?
Please list any gender preferences you have in adopting/fostering a dog:
Please list any other specific information that may help us find a dog for you:
If you are interested in any particular dog(s) on our website, which one(s)?
Please provide the name, address and phone number of at least two personal non-family references:
I understand that a volunteer will schedule a home visit with my family prior to final approval of adoption. Your typed name below is your signature: