Breed desired:
Applicant full name:
Note: Applicant must be over 21
Co-Applicant full name:
Note: Co-Applicant must be over 21
Email address:
Street address:
City:
Zip code:
Daytime phone number:
Evening phone number:
Cell phone number:
Applicant age:
Co-Applicant age:
Why do you want a dog at this time?:
Why do you want this breed: Would you accept a dog
over 20 lbs?:
Would you consider a special needs dog?:
Would you consider a dog that is not housebroken?: What are your thoughts on the use of a crate for your dog?: Applicant's occupation:
Applicant's place of employment:
Applicant's work phone:
Co-applicant's occupation:
Co-applicant's place of employment:
Co-applicant's work phone:
What type of home do you live in? (single family, apartment, condo, mobile
home, etc.): If you rent, please provide landlord's name and phone number: How long have you lived at this address:
How long did you live at your previous address:
Please list all people currently living at this residence, their ages, and
their relationship to the applicant: Do you have a pool or hot tub:
If so, is it fenced/covered so that a dog CANNOT get to it? Explain if
necessary: Home visits are required by rescue. Is this acceptable?
Days and times you are available: Is anyone home while you are working:
Will this person be responsible for the dog: Do you have a completely fenced area on your property:
If no, please tell us how you will address the dog's need for exercise,
bathroom needs, etc.:
Weekdays:
* Weekends:
* Evenings:
*
*
If you will be gone more than 6 hours, how do you plan to potty, exercise
and socialize your dog during the time the dog is alone? (Come home for lunch,
have petsitter or neighbor come over, etc.) Please be specific. :
Where will your dog be kept during the day? (loose indoors, crate, basement,
laundry room, kitchen, other
confined room, fenced yard, chained outside, dog run, outside kennel run, on
lead attached outside, loose
outdoors, garage, dog house, etc.): Please be specific!:
Where will the dog sleep at night? Again, be specific: Who will be responsible for feeding the dog:
How much experience does this person have in housebreaking and training:
How would you handle housetraining:
Who will care for the dog in the event you are ill, on vacation, or
otherwise incapacitated: Have you, as an ADULT, owned a dog before:
If it is no longer with you, please provide a brief explanation of what
happened: Have you ever had an animal die at an early age:
If yes, please explain: Have you ever given an animal to another person, rescue or shelter:
If yes, please explain:
Please list below any pets who currently live in the house. Include their
name, breed, sex, age, years owned, and whether they are neutered :
Are these animals up to date on shots, heartworm preventative, veterinary
care, etc:
If not, please specify which ones and why:
Please describe the dog you are looking for (age, sex, size, etc.). If you are
applying with a specific dog in
mind, please note that here:
Would you consider a dog who is not fully housetrained:
VET REFERENCE: WE WILL REQUIRE THE NAME OF YOUR CURRENT
VET, OR IF YOU HAVE NO ANIMALS AT THIS TIME, A VET YOU HAVE USED IN THE RECENT
PAST. WE WILL CALL THIS VET TO CHECK ON YOUR PREVIOUS CARE OF ANIMALS!!!
Please note: if current or previous animals
have not been kept up-to-date on
shots, heartworm, and
Name of vet's office: Vet's phone number (REQUIRED):
What owner's name are the records listed under:
Groomer reference- if you have a groomer you have used before, please list the
name & phone number here: Additional comments/dog
interested in:
