Name or description of the animal you're interested in adopting *
Phone Number *
Email *
Yard size is approximately how big?
What type of home do you live in? Apartment Condo Rental house Owned house Townhouse Mobile home Other
Please provide your landlord's name and phone number
Your home is in a... * Urban setting Suburban setting Rural setting
Who will be primarily responsible for the financial responsibilities and daily care of the pet? *
Are there any children under the age of 18 living in your home? If yes, what are their ages. *
If you checked Other above, please explain.
If you said yes to the question above, please describe their living conditions.
If applicable, when the dog is home alone, it will be... * Outside, in a kennel/crate Inside, in a kennel/crate Either outside or inside, in a kennel/crate Outside, tied up with a chain Outside, tied up with a cable run Outside, loose Inside, loose Other
If you checked Other above, please explain.
If applicable, how will you exercise your dog? Leash walks every day Will have a cable or dog run in the yard Will be free to run in a fenced yard Will have supervised access to an unfenced yard Will be free to roam (or unsupervised access to an unfenced yard) Will bring to a park on a leash Will bring to a park where dogs can run and play together off leash Other
If you checked Other above, please explain.
Where will/do your pets stay when you go on vacation? Go with you Boarding facility Stay with a friend or family member Stay at home alone and have a pet sitter come by the house Other
If you checked Other above, please explain.
If you checked Other above, please explain.
What are their names, species/breeds, ages, spayed/neutered?
If you've had other pets in the past, please let us know their current disposition: Still have the pets Died of old age Gave away to a friend or family member Surrendered to a shelter or rescue Died for reasons other than old age Was stolen/ went missing Other
If applicable, please explain what happened to your pet.
Please provide the name, address and phone number for your CURRENT and PAST veterinarian/clinic.
If you selected No above, please explain why.
Feel free to provide us with any additional information about yourself that you feel may be relevant.
