Name

First Name

Last Name

Spouse or significant other

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Would you prefer a: *

Male

Female

No Preference

How old a dog are you looking for? *

Under 1 year

1 to 2 years

2 to 4 years

4 or older

No preference

What size dog are you looking for? *

Under 50 lbs

Over 50 lbs

No preference

When are you looking to adopt? *

Right Away

In a few weeks

Over a month from now

How long are you willing to wait for the new dog to become adjusted and bond with you? *

One Week

One Month

As long as it takes

What type of home do you live in? *

Home

Condo

Townhouse

Duplex

Apartment

Mobile home

Other

Do you: *

Own

Rent

If less than a year, please list previous address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does any family member have allergies to animals? *

Yes

No

Don't know

Do you have a regular vet? *

Yes

No

Have you ever taken a dog to obedience class? *

Yes

No

Will you take your new dog to obedience class? *

Yes

No

Will you consult a trainer or behaviorist if your dog develops behavior problems? *

Yes

No

Have you ever been charged with or convicted of animal neglect, abuse, or cruelty of any kind? *

Yes

No

Would you let us visit your home by appointment? *

Yes

No

Do you understand the adoption fee is non-refundable, because this fee is applied toward the medical and boarding expenses that have already incurred for each dog? *

Yes

No