ATTENTION: This is a lengthy form. Please read all instructions carefully and fill out the application as accurately and thoroughly as possible.

Please take a moment to read about our adoption process before filling out the application.


PLEASE ENTER YOUR FIRST AND LAST NAME AS THE SUBJECT.
Home
Home
Cell
Cell
Work
Work
Do you own or rent? *
If renting, landlord name.
If renting, landlord name.
If renting, landlord phone number.
If renting, landlord phone number.
Setting *
Choose the setting that best describes your home environment.
Veterinarian Name
Veterinarian Name
Veterinarian Phone
Veterinarian Phone
Please contact your vet (if you have gone to one with previous pets) and give them permission to speak to us.
Obedience training helps to create a special bond between dog and owner and makes a better canine citizen. Knowing this, are you willing to take extra steps and enroll your dog in obedience classes? *
Enter N/A if this is your first pet.
Select "no fence" if you do not have a fenced-in yard.
In order to answer yes to this question, please be absolutely sure that there are no routes for your pet to leave or other animals to enter your fenced-in area. Select "not applicable" if you do not have a fenced-in yard.
Please indicate for each pet: If still owned • cat/dog/other • name & breed • age • M/F • spayed or neutered? • if no longer owned, why? Enter N/A if no previous or current pets.
Have you ever had to surrender a pet? *
References
Please give us the names and numbers of two references and please let them know we may be calling.
Please indicate name/relationship/phone.
Please indicate name/relationship/phone.
Terms and Conditions
When considering adoption, I understand others have already invested, both emotionally and financially, in the animal's welfare. I acknowledge this involvement and therefore agree to continue their commitment by: 1. Working in partnership with my veterinarian to provide proper care, including vaccinations, heartworm medication and treatments, and spaying or neutering if this hasn't already been done. 2. Providing a safe, healthy and happy environment. 3. Agreeing that decisions about where I choose to live will always include my new furry family member. Thank you for filling out this form that allows us to find the best possible home for the rescued dog we have grown to love.
By signing I affirm that I am at least 21 years of age, and that the information contained on this form is true to the best of my knowledge. I understand that if approved for adoption, I am prepare to make a lifelong commitment of time and money to my pet.
Date *
Date