Current address is a --Select-- Single Family Home Townhome Condo Apartment Mobile home Other

Do you rent or own your own home? --Select-- Own Rent - have obtained permission from Landlord to have a pet Rent - have NOT obtained permission from Landlord to have a pet

If renting, provide landlord's name & number

Do you have an enclosed yard? --Select-- Yes - block wall Yes - wood fence Yes - chain link fence Yes - other No

How tall is your fence?

Any HOA breed or weight restrictions? --Select-- No Yes - the dog I am applying for is NOT on the list of restrictions Yes - I do not know if the dog I am applying for, is on the list of restrictions

How many adults live in the home?

Number of adults over 18 living in the home

How many children live in the home?

Age of children living in the home

Who will be the primary caregiver for the dog?

Is everyone in the household in agreement to adopt this animal --Select-- Yes No Don't Know

Is anyone in your home allergic to animals? --Select-- Yes No

Will the animal be kept inside or outside?

How many hours will the animal be alone each day?

Where will the animal be kept when no one is home?

Where will the pet sleep?

Will you crate your new dog?

Do you have a dog crate?

Have you used a dog trainer in the past? --Select-- Yes No

Would you use a dog trainer if there were any issues with your new dog? --Select-- Yes No Don't know

Do you have a pool? --Select-- Yes - Fence around yard AND separate fence around pool Yes - Fence around yard but no separate fence around pool No

Do you have a doggie door? --Select-- Yes No

Number of pets currently living in your home?

For your current pets, please list the following: species, name, breed, gender, age and temperament?

Example: Dog 1 - Oreo - Boxer/Lab mix - Female- 6years old - energetic temperament

Is your dog(s) or cat(s) fixed? --Select-- Yes No Don't know

Is your dog(s) or cat(s) current on its vaccinations? --Select-- Yes No Don't know

Have you had to euthanize a family pet? If so, why?

Have you ever rehomed or given away a pet? If so, why?

Veterinarian’s name and phone number

What activity level is your home? --Select-- Very Active Active Medium Quiet Very Quiet

Animals need daily exercise to stay healthy. What type of exercise will this dog get and how often?

How much are you willing to spend a year on medical expenses?

Do you agree to keep current license and ID tags on dog at all times?

Do you agree to provide timely vet care for your pet? --Select-- Yes No Don't know

Do you agree to obey all leash laws?

Do you agree to allow the rescue or agents to visit your home prior to adoption? --Select-- Yes No

Do you agree to return your dog to the rescue if you can no longer care for your adopted dog? --Select-- Yes No Don't know

Will you commit to this dog for it's lifetime despite change in your life? --Select-- Yes No Don't know

Who will care for the dog when you travel?

Reason for adopting? --Select-- Family pet Companion for another pet Watch/guard dog Child's pet Hunting dog Gift

Have you or anyone in your immediate family ever been convicted of a charge of cruelty to animals? If so, please explain.

Does anyone in the household smoke? --Select-- Yes No

How did you hear about us?

*I have read and agree to the Terms and Conditions