How did you hear about our dogs?

 

 

Name: 

 

Address: 

 

 

Daytime Phone: 

 

Evening Phone: 

 

Email Address:

 

Date(s) of Birth for Potential Adopter(s):

 

 

 

 

Number of Adults (over 18) in the home:

 

Number of children (and their ages) in the home:

 

 

Residence Type:   Apartment House    Rent Own

 

Length of Residency: 

 

If renting, please list you Landlord's name, address, and phone number:

 

 

Please describe your neighborhood: Is your home in a city, town, country, or suburbs?

 

 

 

 

Are you employed?  Yes No

 

Length of Employment: 

 

Occupation: 

 

What are your work hours?   

 

 

 

What are your household members' work hours?

 

 

How many hours a day will your dog spend alone?

 

 

Do you travel?  Yes No

 

If yes, how often? Who will provide for your animals while you are away?

 

 

 

 

Does your community have a leash law?  Yes No Do Not Know

 

Does your community have breed-specific laws?  Yes No Do Not Know

 

 If yes, please describe:

 

 

Have you considered the daily expenses for maintaining an animal (food, vaccinations, monthly heartworm preventative, monthly flea/tick preventative, unexpected medical expenses, grooming, obedience classes, etc.)?

 

Yes No  

 

 

Are you applying for a specific dog?  Yes No

 

If yes, please name: 

 

Preferred gender:  Male Female

 

Preferred age: 

 

Preferred color: 

 

Can you bring all family members and pets to meet the dog you are considering?  Yes No

 

If no, please explain:

 

 

What qualities would you like to have in your new dog?

 

 

What behaviors would prompt you to relinquish your new dog?

 

 

 

 

Have you considered training classes for yourself and your new dog?  Yes No

 

Under what circumstances would you be unable to keep this dog? 

 

What happened to your previously owned pets?

 

 

 

Do you currently have any dogs in your home? Tell us more about them:

 

When did you get your dog (s)?

 

 

How long have you had your dog(s)?

 

 

Where did you get your dog(s)?

 

 

Does your dog play with other dogs on a regular basis?  Yes No

 

Is your current dog crated?  Yes No

 

Do you have any other pets? Cats?

 

 

Is your cat accustomed to dogs?  Yes No N/A - no cat

 

Is/Are your current pet(s) spayed/neutered?  Yes No

 

 

 

Name of Veterinarian: 

 

Veterinarian Phone: 

 

*Please list the names, addresses, and phone numbers of three (3) references we may call who can attest to your suitability as an adopter. For example, an animal professional (behaviorist, trainer, vet, groomer, educator), a friend who has a dog, your employer, or a coworker.

 

Reference #1 

 

Reference #2 

 

Reference #3 

 

 

 

What type of exercise will you provide for your new dog?

 

 

How often?

 

 

Where will your dog spend his/her day?

 

 

Where will this dog spend his night?

 

 

Do you have a fenced yard?  Yes No

 

Type of Fence: 

 

Height of Fence (in feet): 

 

Approx. size of fenced in area: 

 

If your yard is not fenced, are you considering installing one?  Yes No N/A - already fenced

 

Do you intend to crate your new dog?  Yes No

 

If so, when, why, and for how much time?

 

 

Would you consider working with a professional behaviorist/trainer on correcting problems, should they arise? 

 

Yes No  

 

Additional Comments: