| Today's Date: * |
|
| Dog's Name: * | |
| Your Name: * | |
| Address: * | |
| City: * | |
| State: * | |
| Home Phone: | |
| Cell Phone: | |
| Work Phone: | |
| E-mail Address: * | |
| Name, age, and relationship of those residing with you: * | |
| Is everyone agreeable to adopting a dog?: * | |
| Are you willing to always monitor a child around this dog?: * | |
| Are you willing to welcome this dog as a permanent member of the family?: * | |
| Do everything in your power with the help of your vet to maintain their health? * | |
| Have you considered the following? | |
| a. The financial obligations of responsible pet ownership? * | |
| b. Special need, time and patience involved in getting a rescue? * | |
| c. Who will care for the dog, and where will it be kept? * | |
| Have you ever owned a dog before?: * | |
| Have you ever turned a dog into the shelter before?: * | |
| If so, what were the circumstances?: | |
| Do you currently own any pets? * | |
| Type? (sex, age, species): | |
| Are these pet(s) spayed/neutered?: | |
| If you previously owned a dog, what happened to those no longer living with you? | |
| Type of residence?: * | |
| Own or Rent? * | |
| Do you have a yard? If so, is it fenced?: * | |
| How do you plan on exercising this dog?: * | |
| Are you willing to take this dog to obedience training?: * | |
| Are you willing to live with a dog that has house training issues?: * | |
| If needed, how will you house train a dog?: | |
| Under what circumstances would you not keep this dog?: * | |
| Where will the dog be kept during the day?: * | |
| Where will the dog sleep?: * | |
| How many hours a day will the dog be left alone?: * | |
| How will you care for the dog when on vacation?: * | |
| Any other comments?: | |
| Please attach landlord's statement if a renter: | |