First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone*

Work Phone
x

Cell Phone*

How many people reside in the home? Please give names and ages and specify who will be the primary caregiver of the dog*

Which animal are you interested in (please leave blank if you are seeking pre-approval to adopt or if the dog of interest does not appear in the dropdown menu)
Choose an animal: Cupid Curly Lulu Rudy Starla Tina Weena Trevor Waylon

Please note that your first choice may have other applications on him/her under review that could be approved first. If so, will you consider another dog?

Are you committed to providing a responsible home for your pet’s entire life?*
Choose one: Yes No

Why are you interested in adopting a pet at this time*

List two personal references with their phone numbers and e-mail addresses (if known):*

List Veterinarian(s) and contact phone number(s) for current and previous pets.*

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

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

If you rent, please enter your landlord's name and phone number

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

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence
Choose one: Privacy Chain Link Invisible

What is the height of the fence

Do you currently own any other pets? If so, please list species, breed(s), name(s) and age(s).

Are you financially able to provide for annual exams, vaccinations, heartworm testing, etc.?*
Choose one: Yes No

Have you ever given a pet away or had a pet for a brief period of time and it didn’t work out? If so, please explain *

Under what circumstances would you give up your pet(s)?*

Have you applied with any other rescue*
Choose one: Yes No

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

How much time will the animal spend alone during the day*

Where will the animal be kept when you are not home*

Where will the animal be kept when you are home*

Where will the animal sleep*

Describe how you will train the pet*

How did you hear about us*

COMMENTS/QUESTIONS/HELPFUL INFO ~ Please list any questions, comments, or other information you believe may be helpful in matching you to the perfect furry family member.

SIGN AND DATE ABOVE: By providing a signature above, I certify all of the information I have provided on this application is, to the best of my knowledge true and complete. I understand that falsifying answers on this application, or at any other time during the adoption process, disqualifies me from adoption.*