Contact Info
First Name
Last Name
Street Address
City
State
Zip
Cell Phone
Home Phone
Email
Which animal(s) are you applying for?
About You
Driver's License/ID
Employment Status
Current Employer/School
Length of Current Employment
Please provide two references (name, phone and email)
Your Residence
Do you rent or own?
Rent
Own
Other
If other, please explain
Length at current address?
previous residence, if current residence is less than 2 years
If you rent, does your landlord allow pets?
Yes
No
Other
If other, please explain
Do you have a fenced yard?
Yes
No
Other
If other, please explain
If yes, how tall is it, and is it locked?
Does your home have a dog door?
Yes
No
Other
If other, please explain
Please list all ages of residents in the household
If there are children in the home, what expectations do you have for your child when meeting/caring for your new animal dog?
Do you plan on moving in the foreseeable future?
Yes
No
if yes, where and why
Please provide contact information for current or past veterinarian
Are your current pets spayed or neutered?
Yes
No
Do your current pets wear identification tags?
Yes
No
Are your current dogs licensed?
Yes
No
Are your pet's vaccinations current?
Yes
No
How do you exercise your dogs?
Please list all animals in the household, their breed, age, gender, temperament, and medical status.
Please tell us about your previous animals and experiences?
When left alone inside the home, how will your pet be kept?
When left alone outside the home, how will your pet be kept?
Where will your pet be kept during the day while you are gone? And at night?
How do you plan to introduce your new pet to others already living in the household?
Have you ever taken an animal to the pound?
Yes
No
If Yes, Why
If you are no longer able to care for your adopted animal, do you agree that you will notify [your name ] as soon as possible?
Yes
No
The above statements are true to the best of my knowledge. Type your full name in lieu of signature
Date