First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone
Alt Email
Text/Pager Email
Which dog are you interested in?* Sorry, no animals found
What is your occupation?
What is the best day/time for us to call you?*
How many adults in your household and what are their ages?*
How many children in your household and what are their ages?*
What type of home do you live in?
If other, please describe.
Do you rent or own?
If you rent, do you have landlord approval for this breed and/or size of dog?
What type of fencing do you have?
Do you have a swimming pool?
Please describe your household.
Does anyone in your household have a known allergy to a dog?
Is everyone in the household in agreement with the decision to adopt a dog?
Current Pets: Pet 1 Breed
Sex of Pet 1
Age of Pet 1
Spayed/Neutered Pet 1
Status of Pet 1
Pet 2 Breed
Sex of Pet 2
Age of Pet 2
Spayed/Neutered Pet 2
Status of Pet 2
Pet 3 Breed
Sex of Pet 3
Age of Pet 3
Spayed/Neutered Pet 3
Status of Pet 3
Pet 4 Breed
Sex of Pet 4
Age of Pet 4
Spayed/Neutered Pet 4
Status of Pet 4
What other pets do you have? Please specify type and number.*
Have you ever lost, given up, or euthanized a pet. If so, why?
If you have not had any animals in the last 5 years, please detail your experience with animals.
Who will be the vet for this pet? Please provide name, city, and phone number.
Do you plan to take this dog to obedience class? If so, where.
Are you willing to housebreak a dog?
What would do to housebreak the dog
What is it about this dog that interests you?
In what activities will this dog participate with you and your family?
Is someone home during the day? If so, who?
Where will this pet be kept when you are home?
Where will this pet be kept when alone?
How many hours per day will this pet be alone?
Where will the pet sleep?
Willing to have a home check?
What are you personally willing to give up a pet for?
What would you do for chewing?
What would you do for digging?
What would you do for Barking
What would you do for Separation Anxiety
What if a pet gets sick?
How did you hear about us?
Anything else you would like us to know?
