| Dog name and shelter ID#: |
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| Your name: |
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| Current date and time: |
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| Home address (Street Name and Street Number): |
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| Home address (City, State, and Zip Code): |
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| Home phone: |
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| Cell phone: |
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| Email: |
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| Your employer: |
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| Length at current job: |
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| Personal reference 1(Cannot be related to you) |
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| Their phone number: |
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| Relationship with person and years known. |
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| Personal Reference 2(Cannot be related to you) |
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| Their Phone Number: |
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| Relationship with person and years known. |
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| Do you live in: |
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| Do you rent or own: |
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| If you are renting, is your name on the lease?(If You Own Put N/A) |
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| If you are renting, do you have your landlords permission?(If you own put N/A) |
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| Landlords name and phone:(if you own put N/A) |
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| Name and age of all household residents: |
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| At what age do you believe children are responsible enough to care for the dog unassisted: |
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| Is anyone in your house allergic to dogs?: |
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| How many hours will your dog spend alone each day?: |
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| Where will Your dog spend the day when you are home? |
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Where will your dog be kept when left home alone?: |
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| When will your dog be outside?: |
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| When will your dog be inside?: |
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| Where will your dog sleep?: |
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| What area(s) outside are available to your dog? |
Front YardBack YardEnclosed PatioDog HouseGarageOther(explain in additional comments) |
| Do You Have A Doggie Door?: |
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| Is your yard shared with neighbors?: |
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| Is your yard fenced?: |
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| If es, what type of fence and how tall is it: |
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| Describe your dog owning experience: |
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| Have you ever had to give an animal away?: |
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| What were the circumstances?(if you never have, put N/A) |
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| Do you currently have pets?: |
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| Current pet breed, type, gender, age, spayed/neutered?: |
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| What is your veterinarians name and phone number?: |
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| What energy level are you looking for?: |
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| Why do you want a dog?(select all that apply) |
Family PetCompanionGift For Someone ElseProtection/Guard DogChilds CompanionCompanion For Other PetOther(Explain in additional comments field) |
| Will you be crate training your dog?: |
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| How will you exercise your dog and how often?: |
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| What type of training are you interested in with your dog?: |
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| Have you or would you be willing to enroll your current dog in obedience class: |
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| How would you discipline your dog if they misbehaved?: |
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| What method will you use to housetrain your dog?(Select all that apply) |
Rub Nose In Offending SpotCrate TrainingDo Not Leave Dog UnsupervisedConsult ProfessionalLet Dog Out Every Few HoursOther(explain in additional comments) |
| What will you do if your dog develops behavioral problems?: |
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| In which situation would you let your dog off leash?(Select all that apply) |
Public ParkDog ParkBeachHikeNeighborhood WalkFront yardBackyardOther(explain in additional comments) |
| What would you do if your dog went missing?: |
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| Can you afford proper medical care, diet, grooming, shelter, and exercise for your dog?: |
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| Will you take your dog to the vet within 10 days of adoption?: |
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| Do you understand that your adopted animal may require vet care as a result of shelter related illness?: |
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| Are you committed to caring for this dog for 15 or more years? : |
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| If you move what will you do with your dog?: |
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| Which of the following reasons provided might force you to give up your dog?(select all that apply) |
Excessive Barking/ Neighbor ComplaintsAggressive On LeashDestructive ChewingBiting/AggressionDiggingDivorce/SeparationAllergiesShedding/DirtyNot TrainablePoor WatchdogMovingHouse Training ProblemsFinancial ProblemsGrowling/Nipping at GuestsExcessive Vet Bills/ Chronic illnessHaving a BabyNips Or Bites ChildrenNew Spouse does not like dogsPets Aren't Getting AlongNone Of The AboveOther(Please explain in additional comments) |
| Do you have any additional concerns? |
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| Do you have any additional comments?(this is where you explain why you selected other) |
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| Sign And Date: |
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