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Dog Application Form  

Please provide as many details as possible.
Please fill in all fields marked with a *
Feel free to type at length, even the small looking fields will accept a large response.
Feel free to add more details in the elaboration field at the end.
Who are you interested in adopting? *
Your Name: *
Residence Street Address, City, State and Zip: *
Home Phone Number: *
Mobile Number:
Email Address: *
Who lives with you? (name and age of each human)
Does anyone in the household have health concerns which should be considered when choosing a dog?
What pets live with you currently? (Species, breed, age)
Your Occupation: *
Do you work from home? *
Hours per day dog will be alone: *
Are you able to provide doggy daycare? *
Why are you interested in adopting this particular dog? *
What qualities are you looking for in a dog? *
What qualities would not be a good match for you and your household? *
Dogs can become ill and incur large veterinary bills. Are you financially able to manage an unplanned surgery or other injury or health related medical bills? *
Will your dog be tethered outside? *
How will your dog travel in the car or truck with you? *
Where will your dog sleep? *
List any areas of the house that the dog will not be allowed: *
Will the dog be allowed on furniture? *
Is a non-fully-housebroken dog a deal breaker for you? *
If no, describe your limits pertaining to potty training issues:
Are you willing to use puppy pads or diapers or belly bands as tools to help potty train your dog?
Do you feel comfortable adopting a dog which may have food or resource guarding issues?
When you travel where will your dog stay? *
Are you in a private residence with a yard, a condo or apartment with no yard? Is your yard fenced? Please describe fencing (height and material) if applicable. *
Do you have a friend or relative who is willing to care for your dog should you become unable to do so for an extended period of time? *
Their name:
Their phone number:
Their email:
Please provide your veternarian as a reference: *
Do you have a regular groomer? *
If yes, please provide a name and contact information:
We would like to have one personal reference. You may provide more than one. It can be a family member, neighbor, co worker, or friend. Please provide their name(s) and phone number(s).
Please feel free to elaborate on any questions asked above and/or share information about yourself and lifestyle which would help all of us determine if this dog could be a good match for you.