Personal Information
First Name Last Name Age E-Mail
Address City State Zip
Occupation Work Phone
Cell Phone Home Phone
Briefly tell us about the other adults in your household
Name Relationship to you Age
Name Relationship to you Age
Name Relationship to you Age
Briefly tell us about any children in your household
Name Relationship to you Age
Name Relationship to you Age
Name Relationship to you Age

Residential Information
If your application is approved will you consent to a home check.  Yes  No
Do you live in a   house   apartment   other 
Do you  own  rent  live with family  live with friends
Does your residence have:
a fenced yard
a doggie door
a patio
a porch
yes no
yes no
yes no
yes no
If you're renting your residence please answer the following:
Landlord's name Phone number
Does your landlord:
Allow pets
   Yes     No     Don't know  
Have size restrictions
   Yes     No     Don't know  
Charge a deposit
   Yes     No     Don't know  
Charge extra rent
   Yes     No     Don't know  
Your new pet
Which animal are you interested in adopting ?
Why are you planning to adopt a dog? (check all that apply)
   For a companion    For hunting    Bark at strangers
   For yourself    For your family    Buddy for another pet
   As a gift    As a guard dog    Running partner
What qualities are you looking for in a new dog?
Please list any concerns you have about your new pet,
or any questions you may have for us.
Do you have experience training dogs for any of the following:
Obedience
Housebreaking
Agility
Other
yes no
yes no
yes no
How will you deal with destructive behavior like chewing, digging, or jumping?
What will you do if your new dog bites or snaps at a family member?
Who will have the primary responsibility for the following:
Feeding  
Obedience
Vet Care
Exercise   
Routine health care can cost up to $300.00 a year and emergencies are often over $1,000. Are you willing to provide this care if necessary ? Yes  No
Where will your new pet be kept:
At night
If you move
During the day
When on vacation
On an average day how long will the pet be left alone?   
How many days a week?   
What will you do with your new dog if you can no longer keep it?
Will your new pet be allowed
On the bed Yes No In the car Yes No
In the pool Yes No In the yard Yes No
In the house Yes No On the couch Yes No
Current or Previous Pets
How many pets do you have now?
Dogs
Cats
Others
Are your current pets vaccines up-to-date?   
  Yes  No  Don't Know
Are they all spayed and neutered?
  Yes  No  Don't know
Current veterinarian's name:
Phone #
May we contact them to ask about your current pets? Yes No
Have you ever had to relinquish an animal to a shelter? Yes No
If so, what were the circumstances?
How many pets have you had in the last 10 years?
Dogs 
Cats 
 Others 
Where are they now?
Please tell us a little bit about your previous pets and anything
else you would like us to know about your current pets.
Thank you for taking the time to complete our application.
We will review it shortly and contact you very soon.
Click the submit button to send us the form, and return to our home page.