First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Which animal are you interested in?*
Choose an animal: Amber Blanca Hippy Larry Nicky Pixie Rowan Tabith tigTiggerger Tori vanna

Your age and occupation?*

Please give us the name and phone number of someone who's familiar with your pet care*

How did you hear about us?*

What type of dwelling do you live in?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing Farm Patio Home Other

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

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

Are you planning to move in the next six months?*
Choose one: Yes No

What will happen to this pet if you move unexpectedly*

Who will be responsible for care of this pet if you are on vacation or move unexpectedly?*

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

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

Where will the animal be kept when you are home*

Does your home have a dog door*
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

Does your gate have a lock
Choose one: Yes No

If your gate does not have a lock, are you willing to add one?
Choose one: Yes No

If you do not have a fenced yard, how will you exercise your dog

If the yard is not fenced, who will walk the dog and how often

What type of vehicle do you own

How will your dog be transported*

What are your reasons for adoptiong this dog at this time

For whom are you adopting this dog
Choose all that apply: Family pet For my children Gift Myself

Please list the names and ages of those living in the household, along with the relationship to the adopter*

Does the entire family agree to the adoption of this pet*
Choose one: Yes No

Will the entire family share in the care of this dog

Is anyone in the household allergic to cats/dogs?*

Are there children who frequently visit

If yes, what are the children's ages*

Are there regular visitors to your home (human or animal)

If yes, please describe visitors*

Tell us about your current pets. Include the name, species, breed, age, time owned and if they are spay/neutered.

Tell us about your past pet experience. Please include name, species, breed, age, time owned, if they were spay/neutered, and what happened to them: did they pass away? Get lost? Given away? Etc.*

Do you have a regular veterinarian

Please provide your vet's name, address, phone number*

May we call your veterinarian

How often do you think a dog should see a vet*
Choose one: Annually Only as needed - treat at home Twice a year When it's sick

What do you know about heartworms *

What food do you plan on feeding your pet?*

What behaviors do you find unacceptable in a pet*

If your pet has a behavior problem, what will you do about it*

Please sign and verify the answers are correct by typing your name and the date*

Do you have any comments or questions for us