New Adoption Form

List pets owned past 3 years, type of animal, spayed/neutered?, vaccinated? what happening to them

Number of adults/kids in household/ ages

Name of dog applying for *

When you go on vacation, who will care for your dog? *

Who will be responsible for this animal?

Do you live in house or appartment *

Under what circumstances would you surrender a dog? *

Please note:Submitting application online is for convenience only. Application will not be considered until you have come to meet the dog. I have read the above information carefully and have filled out this application honestly. I understand the omission of information, telling untrue information and or failure to answer all questions and sign application can result in application being declined. Please list your name below *

Are you willing to take time to housebreak and train the dog? *

Address

Any circumstances you would like us to know about? *

Applicants name (First, middle, last) *

Personal reference (name and phone)

What is your occupation?/ income range *

Reasons for adopting a dog?

Do you plan to tie or chain the dog outside at any time? If yes, please explain *

Estimate how much it will cost to provide food, vet care and supplies for a dog for one year *

If you move, do you plan to take the dog with you? *

Do you understand that some dogs may not be housebroken and that changing their environment may cause dog to have accidents and or destroy household items? *

Home phone *

If a disciplinary or behavioral problem arises with your dog, what steps will you take to work on it? *

Email *

Do you have a fenced yard? If yes, what type and height of fence *

If you rent or live with parents, so you have permission to have a dog? *

Are you willing to take responsibility for this dog for the next 10-15 years? *

todays date *

alternate phone

Where will dog be kept during the day and at night? *

Any family members with allergies to animals?

Do you own or rent? Roommates or live with parents? *

Are your familiar with local animal ordinances? *

How many hours a day will dog be alone? *

Vet reference, name and phone

Part of the adoption process is a home visit. Are you agreeable to this? *

Dale of birth *