Adoption and Fostering Application

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Occupation
Work Phone
Home Phone
E-mail

Did you see a dog on our web site you are interested in?
            If so, what is it's name?   

Family Data: Choose one of the following options:  Single  Married  Living Together

Housing: Choose one of the following options:  House  Condo  Apartment
Own/Rent: Choose one of the following options:  Own  Rent
How long at current address (years)?       

What are your ages (adults in the house)?        

Does you occupation require frequent travel?   Yes No
If so, who would care for the dog in your absence?

Do you have children in the household?   Yes No
If so, what are their ages? 

Are there others in the household? 

Please list all pets currently in the household and those that you have owned for the last five years. 

Please indicate the pet Type (Breed), Sex (male vs. female), it's Age, whether it was Spayed/Neutered and Where is it now (with you, passed, etc).

            Example: Shepherd Mix, Male, 3, Neutered, Lost

If you have a vet, please give us his/her name, address and phone number.

Have you ever bred a dog?  Yes No

Do you intend to breed dogs?   Yes No

Have you ever sold, given away or put a pet in a shelter?  Yes No
 If so why?

How did you hear about our rescue?

Do you have a fenced yard?   Yes No
What kind of fencing?  

How high is the fence (feet)?  

How high is the gate?  

Doe the driveway enter the back yard?

Yes No

Where will the dog stay at night?

Where will the dog stay during the day?           

What hours will the dog be alone?

  0 - 2 Hours 2 - 4 Hours 4 - 8 Hours 8 - 12 Hours More than 12 Hours

How would you correct a dog who misbehaves?  Verbal Reprimand  Physical Reprimand

How do you feel about a dog that digs?  Acceptable  Not Acceptable

How do you feel about a dog on the furniture?  Acceptable  Not Acceptable

Are you interested in adopting a:  Male  Female  No Preference

Do you have a preferred age range?  If so, please enter it here.  

Are you interested in a specific breed(s)?  If so, please enter here.  

Are you willing to take your adopted animal to Obedience School?   Yes No

By submitting this application, you acknowledge that the information supplied is true and accurate. Misrepresentations of fact may result in the removal of the adopted animal from your home. Once a dog is adopted, if it is found to be neglected or abused, we reserve the right to reclaim the dog.