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Application (Courtesy Listing Dogs)
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* Indicates required question
Email
*
Your email
Name of dog you are interested in:
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Your answer
When would you would be ready to take the dog/puppy home?
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Your answer
I would prefer:
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puppy
adult dog
senior dog
Required
Breed/mix preference?
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Your answer
Preferred size when full grown?
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small
medium
large
extra large
Required
Energy level ?
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Your answer
House trained or willing to train?
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Your answer
Your name:
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Your answer
Date of birth:
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Your answer
Address:
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Your answer
Telephone # and Work #
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Your answer
E-mail address:
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Your answer
Are you:
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working
retired
attending school
homemaker
other
Required
Maximum number of hours pet will be alone daily:
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Your answer
Name(s) of each adult in your home:
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Your answer
Age(s) of children in the home:
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Your answer
Age(s) of children that visit frequently:
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Your answer
Have children been around dogs before?
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yes
no
Required
Why do you want to adopt a dog?
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companion
guard dog
other
Required
How many pets have you had in the last 10 years?
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Your answer
Type of pet and pet's name
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Your answer
Age of pet and if spayed/neutered
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Your answer
How long have you had (did you have) pet?
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Your answer
If you no longer have pet, why not?
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Your answer
Type of pet and pet's name
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Your answer
Age of pet and if spayed/neutered
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Your answer
How long have you had (did you have) pet?
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Your answer
If you no longer have pet, why not?
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Your answer
List additional pets and their information.
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Your answer
Are your pets kept inside or outside?
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Your answer
Where are your pets kept when you are not home?
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indoors
crated
basement
outdoors
tie-out/dog house
garage
fenced yard
Required
Does anyone in your home have allergies to dogs?
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Your answer
Do you rent or own? If you rent, you must provide landlord's name and phone number.
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Your answer
Is your yard fenced? And if so, what type of fence?
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Your answer
Are you able to leash walk your dog?
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Your answer
How will you correct inappropriate behavior?
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Your answer
How will you "housebreak" your dog if he/she is not housebroken?
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Your answer
Have you ever given a dog or puppy away?
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yes
no
Required
If you have given your pet away, please provide details.
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Your answer
Have you ever had an animal taken away from you by dog control or animal control?
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yes
no
Required
Please list any behavior problems you could not tolerate:
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Your answer
Is a home visit acceptable to you?
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yes
no
Required
Provide your vet's name and phone number.
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Your answer
List three (3) references including phone numbers. Please include the email address for your references whenever possible. Please include at least one neighbor and a co-worker or friend.
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Your answer
Signature and date:
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Your answer
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