* Required Fields

Select a Date

Dog Applying For

Full Name

Address

City

State

Zip

Phone

Cell Phone

Home Owned by

How long in current home

If yes, HOA contact name

HOA contact phone #

Homeowner's Insurance Name

Insurance Phone #

Type of Fence (Wood, Vinyl, Chainlink, Metal, Other)

Fence Height

Number of Adults in the home?

Number of Children in the home?

Ages of Family Members (ex. 30, 35, 10, 2)

How would you describe your household (ex. Active, Mellow, Quiet)

Species (Dog, Cat)

M/F

Pet Age(s)

Time Owned

Are you opposed to crate training?

Spay/Neuter (Req'd by rescue)

If your dog is not spayed or neutered, please tell us why.

Are your current pets good with people? other animals?

Do you have cats?

Are your current pets up to date on vaccinations?

If no, please explain.

Current veterinarian or N/A

Veterinarian Phone # or N/A

What type of activities will you do with your new dog?

When you are home, where will the dog be kept?

How long/often will the dog be left alone? (ex. work day incl travel time)

When no one is home (ex. work, shopping, etc.) where will the dog stay?

Is there anything else you would like us to know?

Please be honest when completing this application. There are no wrong answers. The questions help us to place our dogs in the right homes.

Thank you!