First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Alt Email

You must be 21 or over to submit an application*

Which dog are you interested in adopting? (You do not HAVE to choose a dog)*
Choose an animal: ***Any Dog/Not Listed Baxter Bluey Bobby Bonsai(Tabby ) and Mr Wick ( Black ) BONDED PAIR Brody Cooper Dixon Duke Felix Fiona Flash Jasper and Jett BONDED PAIR Juliana Kiki Mari Mr Wick (black) and Bonsai (tabby) BONDED PAIR Odin Rusty Poodle Sandy Spicey Wheezy

List the names of any other dogs you are interested in adopting, or describe the type of dog you are interested in adopting*

Applicant Date of Birth*

Applicant Occupation (if retired, student or other please describe)*

Employer Name (retired, student, etc)*

Employer Phone Number (type N/A if retired, student or self-employed)*

PERSONAL REFERENCE #1: Name, Relationship to you, Address and Phone Number ***(Only one (1) can be a family member who DOES NOT live in the same household as you) LET THEM KNOW WE WILL BE CALLING*

PERSONAL REFERENCE #2: Name, Relationship to you, Address and Phone Number ***(Only one (1) can be a family member who DOES NOT live in the same household as you) LET THEM KNOW WE WILL BE CALLING*

Veterinarian's Name, Address and Phone Number (if more than one please list all), if None enter NONE.*

If you do not have a Veterinarian reference - we require a 3rd PERSONAL REFERENCE: Name, Relationship to you, Address and Phone Number *** (not a family member) LET THEM KNOW WE WILL BE CALLING

PET HISTORY: List all animals (current pets first followed by pets that have passed away) that have resided with you within the past 10 years. For each, include ALL of the following information: (1) Type of animal; (2) Breed; (3) Name; (4) How long they resided with you; (5) Were they up to date with inoculations; (6) Spayed/neutered? If not spayed/neutered or were not up-to-date with inoculations, please explain. (7) Is the pet alive or deceased?; If the pet is not deceased, but no longer living with you, please explain. If you have never owned a pet before, enter NONE * *

Do you have any cats? Are the cats de-clawed? *

HOME: Is the applicant listed the owner/renter of the home? If not, list owner's name and phone # here, they must approve adopting a dog.

In what type of home do you live?*
Choose one: Single Family Condo Townhouse Apartment

Do you own or rent your home?*
Choose one: Own Rent

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent or have an HOA, provide 1. Landlord/Management Company Name 2. Phone Number

List ALL people living in the home (1) NAMES (2) RELATIONSHIP TO YOU (3) AGE - If you are the only household member Answer: NONE*

Who will be primarily responsible for caring for the dog?*

Do you have a fenced in backyard? If so 1.Full or Partial 2.What type of fence and how high - if you have NO fence Answer: NONE*

How do you plan to exercise your dog*

How do you plan to train your dog?*

On average - how much time will the dog spend alone during the day?*

Where will the dog be kept when you are NOT at home?*

Where will the dog sleep at night?*

Where will the dog be when you are away on vacation or an extended period of time?*

Describe any breed PREFERENCES you have. If you are not concerned about breed - Enter: ALL BREEDS ***We cannot guarantee the breeds in mixed breed dogs*

Do you have a full-grown size preference? (select all that apply)

What traits are you looking for in a dog?

Dogs may need an adjustment period after adoption. Are you dedicated to work with your dog until they fully adjust to your home environment?*

The average annual cost to support a healthy dog is approximately $500-$750. Are you financially willing and able to provide vaccines, routine exams, sick visits and potential surgeries that come as part of owning a dog?*

Have you ever given up or re-homed an pet? If yes, explain in detail, why and where the pet is today - If you have NEVER given up a pet Answer: NA*

Ask questions about a specific pet that is not in their description

Would you consider fostering a dog now or in the future?
Choose one: Yes Not Sure - I would like more information No