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Dog Adoption Application

1Applicant

2Family

3Home

4Care

5Preferences

This field is hidden when viewing the form
Default: Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country
Home Phone Number
Work Phone Number
Cell Phone Number*
- Preferred Method of Contact*
- How Did You Hear About Us?*
- What Is Your Friend's Name?
- Which Shelter?
- Which Rescue?
- Please Describe

Residence
- Type of Residence*
- Please Describe Type of Residence
- Do You Own or Rent?*
- Does Landlord Allow Dogs?*
  - Yes
  - No
- Are There Any Breed Or Size Restrictions?*
- Please Provide Landlord's Name*
- Please Provide Landlord's Phone Number*
Yard Information
Do You Have A Yard?*
- Yes
- No
Is The Yard Fenced?*
- Yes
- No
How High Is The Fence?*
What Is The Lowest Point of The Fence?*
What Material Is The Fence Made From?*
Please Describe Fence Material*

Family & History
- What Type Of Household Do You Have?*
- Please Describe*
- Do All Family Members Want A Dog?*
  - Yes
  - No
- Please Explain Who Doesn't and Why They Don't*
- Is Any Member Of Your Household Allergic To Dogs?*
  - Yes
  - No
Are You WIlling To Take Responsibility For This Dog For The Next 10-15 Years?*
- Yes
- No
What Provisions Will You Make For The Dog Should You Become Unable To Care For Him/Her?*
- Are You Capable of Providing Timely Healthcare?*
  - Yes
  - No
- Please Explain Your Circumstances*
Feeding & Exercise
- Do You Plan On Walking Your Dog Daily?*
  - Yes
  - No
- Who Will Be Responsible For Walking The Dog?*
- What Other Means of Exercise Do You Plan On Providing The Dog?*
Sleep & Alone Time
- Where Will The Dog Sleep?*
- Where Will The Dog Be When Alone?*
- Please Describe Where The Dog Will Be*
- Do You Have A Doggie Door?*
  - Yes
  - No
- Is It Locked When You Are Away From Home?*
  - Yes
  - No
- If You Are Gone From Home During The Day, Does Someone Let Your Dogs Out?*
  - Yes
  - No
- What Is The Longest Time The Dog Will Be Alone (without humans)?*
Behavior & Training
Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Dog Comfortable In Your Home?*
- Yes
- No
Which of the behaviors would you like more information on?
Needs Social Skills*
Accidents In The House*
Inappropriate Chewing*
Excessive Barking*
Digging*
Separation Anxiety*
- Other
  - Yes
  - No
- Please Explain Other Behaviors You Cannot Tolerate*
- What Are Your Plans For Training Your New Dog?*
- Please Describe Your Training Plans*
Personal Reference
Please Provide A Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Veterinarian Information
Have You Used A Veterinarian Before?*
- Yes
- No
Please Provide Veterinarian's Name*
Please Provide Veterinarian's Phone Number*
Would you like information on local veterinarians?*
- Yes
- No

Would You Consider:
- A Dog that Has Special Needs?*
- Please Select All Special Needs(s) You Would Accept*
  Select All That Apply:
- A Dog That is Not Completely Housebroken?*
Select Gender*
Select Age Range*
Select All That Apply
Select Personality*
Select All That Apply
Select Color*
Do You Have A Preferred Dog?*
Note: This does not guarantee this dog will be placed with you
List Other Dogs You Are Interested In
When Will You Be Ready To Adopt?*
Is There Anything Else You Would Like to Let Us Know?
I am interested in receiving pet related services and products*
- Yes
- No
Authorization
Authorization:*
By checking this box, you confirm that all answers are accurate. If you adopt a pet, this application will become part of your contract. Providing false information or violating the contract terms may result in legal action.*
- I agree
Phone
This field is for validation purposes and should be left unchanged.

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