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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?
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Front YardBack YardEnclosed PatioDog HouseGarageOther(explain in additional comments)
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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)
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Family PetCompanionGift For Someone ElseProtection/Guard DogChilds CompanionCompanion For Other PetOther(Explain in additional comments field)
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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)
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Rub Nose In Offending SpotCrate TrainingDo Not Leave Dog UnsupervisedConsult ProfessionalLet Dog Out Every Few HoursOther(explain in additional comments)
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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)
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Public ParkDog ParkBeachHikeNeighborhood WalkFront yardBackyardOther(explain in additional comments)
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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)
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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)
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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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