Please provide the following information:

First name
Last name
Occupation
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
E-mail

Reference

Reference Telephone

How Many Years?

Do you own or Rent your home?

Rent Own

If Renting - Enter your landlords name/telephone:

Do you have a fenced yard?

If not - how will you train the dog to relieve himself?

How many adults in your home?

How many children in your home?

How old are the children?

Do you own any other dogs?

Which breed(s)?

How old are the other dogs in the home?

What sex are the other dogs?

Are the other dogs spayed/nuetered? If not, why not?

When was the last heartworm test?

Where does your dog(s) spend most of the day?

What brand of heartworm preventative do you use?

Do you own any other type of pets/livestock?

If yes, please describe:

Who is your veterinarian?

Veterinarian Telephone:

How many dogs have you owned in the last 5 years?

What happened to your last dog?

Where will the dog spend most of the day?

Where will the dog sleep?

How many hours a day will the dog be alone?

Have you ever adopted a dog from a rescue or orginization before?

If so, which breed(s)?

Are you willing to adopt an older dog?

Are you willing to adopt a dog with special needs?

Can you foster?

If you can foster, is short-term and long-term ok?

Do you have a crate available?

Which dog(s) are you interested in adopting?

Please tell us anything about you and your family that you feel is important and/or helpful:

Do you agree to allow a rescue volunteer to visit your home prior to adoption approval?