Today's Date
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Which dog are you interested in?
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How did you hear about the dog you are interested in? (e.g. Facebook, Petfinder)
PERSONAL
First name
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Last Name
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Date of Birth (you must be 21+ years of age)
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Address
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City
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State
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
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Phone Number(s)
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Email Address
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Occupation
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Employer
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Who will be the dog’s primary caregiver?
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List names, birthdates, and relationships of everyone else in your household. Note: We do background checks on all adults in the household so dates of birth are imperative.
RESIDENCE
If rent, provide landlord's contact info
If yes, please describe (Note: homes with electric/underground fences will not be considered)
If your yard is NOT bounded by a fence, how do you plan to keep the dog safe while outdoors?
PET HISTORY
If yes, please describe (name, age, breed, gender)
If you have cats, please describe (name, age and gender)
If you ever surrendered an animal to a shelter or re-homed any animal that you have owned, please explain the circumstances.
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List any pets you have had in the past 10 years that you have not already listed above (name, breed):
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DOG INFO
What you are looking for in a dog?
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Where will the dog be kept during the day?
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Where will the dog be kept at night?
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What is the longest the dog would be alone during a typical 24-hour period?
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What brand of food would you feed the dog?
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How do you plan to give the dog daily exercise?
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The dog you want to adopt may have an adjustment period, which could mean accidents, chewing or other behaviors. How would you handle this?
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Additional information you think would be helpful for us to know:
TWO PERSONAL (NON-FAMILY) REFERENCES
First Reference (Name, relationship, phone)
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Second Reference (Name, relationship, phone)
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OTHER REFERENCE
Name and phone of veterinarian
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FOR FOSTERS ONLY
CONSENT / RELEASE
If you are human, leave this field blank.