Home Telephone: Work Telephone: e-Mail: Do you presently care for/own pets?:yes/no If yes, please list name, species and breed: If dogs are present, are each spayed/neutered? yes/no If no why?
Are there dogs no longer in your household? yes/no
What happened to those animals?
Please provide name and telephone number of your current vet: If you do not have a vet list name and phone number of vet you will be using: How many children living in household?:
Age of Children?
Do you own or rent?: Do you reside in a house, apartment, other?: Of renting, do you have landlord permission?: yes/no Landlord phone number: If you have a fence, what kind: How many hours if any will your dog be left unattended?: Where will your dog be kept while you are away?: Do you have enough crates to house dogs in your household?: yes/no Where will the dog be kept while you are on vacation?: Why are you interested in adopting a dog?: Will you allow a home visit prior to to adoption?: yes/no Will you enroll the dog in obedience classes if necessary?: yes/no Will your dog always be on a lead when inopen spaces?: yes/no Please provide the name and telephone number of 2 personal references:
NOTE: Please contact your vet and authorize them to release medical information.