Adoption ApplicationName* First Last Email* D.O.B.* Date Format: MM slash DD slash YYYY Spouse / Significant Other's Name First Last D.O.B.* Date Format: MM slash DD slash YYYY List all others living in household, with agesAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneOccupation / How LongName of EmployerSpouse / Significant Other's Occupation / How LongSpouse / Significant Other's Name of EmployerVeterinarian InformationVeterinarian's NameVet Practice Name*Vet's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Vet's PhoneVet's FaxReferencesPlease provide info on two individuals not related to you who can serve as references.Name (Reference 1) First Last Phone (Reference 1)*Name (Reference 2) First Last Phone (Reference 2)*Relative's NamePlease provide the name, address and phone # of your nearest living relative First Last Relative's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Relative's PhoneDo you own or rent your home?OwnRentHow long have you lived at your current address?If renting, do you have your landlord's permission to keep dogs?YesNoN/ACan you provide us with such permission in writing?YesNoN/AAdoption InformationI am interested in (Choose all that apply)Fostering is a good way to find out if you really want to live with a pet. Adopting Fostering May we visit your home and check the references to verify the information you have providedYesNoList the pets you've owned in the past 7 years. (Past & Present, leave blank if none)Please list names, ages, health of each living pet, breed, and how many you have currently. Cause of death for deceased pets.Are current pets spayed or neutered? If not, why?Why do you want a pet?Is everyone in your home agreeable to getting a pet?YesNoIs anyone in your household allergic to dogs?YesNoHave you ever owned a dog before?YesNoHow have you educated yourself about this dog?What is your philosophy regarding pets and children?Describe the grooming care you would provide for your petWhat do you anticipate the cost will be to provide basic care for your dog?Including Grooming, Vet care, supplies, dental cleanings, food, license, toys and bed$100/Year$500/YearMore than $500/YearWhat do you plan to feed your pet?Be specific about the brand.Are you willing to change?YesNoDog(s) interested in: *Please list the dog's name (if known) or characteristics of pet you are interested in.Please list your preference regarding genderMaleFemaleNo PreferencePlease list your preference regarding AgeLess than 2 years2-5 yearsOver 5 yearsNo preferenceWould you consider a special needs dog?YesNoMaybeWill you consider something other than your stated preference?YesNoWhere will you keep your dog?Please be specificDuring the day?CratedFree to roam insideFree to roam outsideFree to roam with dog doorDuring the night?CratedFree to roam insideFree to roam outsideFree to roam with dog doorDuring vacations or while you are away overnightPet sitterAt vetsLeave with friendBoardedCratedFree to roam insideFree to roam outsideDo you have a safe and securely fenced yard (well maintained: no loose boards, no gaps, holes or protruding nails)?YesNoHow large is the area that is fenced?PatioLess than 200sq ftSmall (10ft x 30ft)Medium (20ft x 40ft)Large (60ft x 100ft)1/2 AcreOver 1/2 AcreN/AWhat type of fencing do you have and how high is it?Type, height, gate?, dog door?If you do not have a fenced yard, how do you plan to exercise your dog?Do you have a pool? Is it fenced?How often and how long will you walk your dog?If you are gone from the home on a daily basis, give a breakdown of your daily routine including sleep, work, meetings, errands, eating out, school functions and any other regularly scheduled eventsWhat category best describes your household's scheduleWork at homeWork outside home, flexible scheduleRetiredFixed work scheduleHecticSomewhat hecticOrganizedSo organized its boringRealistically, how many hours a day will you spend with your dog (excluding sleep)?Are you able to come home in the middle of the day to walk the dog and/or give it a chance to relieve itself?YesNoWhat is the maximum number of hours your dog will be left alone during a 24 hour period?How many of these hours will the dog be confined without a chance to relieve itself?Where will the dog spend this time (please be specific)When you are away from home, will your dog have companionship?What will you do if your dog is destructive when left alone?Are you willing to attend obedience classes with your dog?YesNoHave you ever trained a dog before?YesNoHave you ever surrendered a pet of yours to an animal shelter?YesNoIf Yes, why? Give DetailsHave you ever sold or given away a pet?YesNoTo whom, why?What circumstances, in your mind, justify giving up/relinquishing a dog?What circumstances justify euthanizing a dog?Agree to Proceed Thank you for taking the time to complete this application. By entering your name below, you attest to the truthfulness of your answers, and agree that we may verify any part, or all of your answers contained in the application, and may take any other investigative steps necessary to ensure the adoption applicant(s) is/are suited to adopt a dog. Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog. Signature*I agree to the above termsDate* Date Format: MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.