Name
*
First Name
Last Name
Email
*
Phone
*
Cell
(###)
###
####
Phone
Home
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How did you hear about us?
Veterinarian
Friend or Family
TikTok
Facebook
Instagram
Another Rescue
From another foster or adopter
Why are you interested in adopting?
*
Please list all the humans in your home and their ages.
Please list all the animals in your home:
Name, Type, Age, Sex, Spayed/Neutered (please include livestock or poultry)
Do you have a secure way to keep your adopted dog SEPARATE from the other animals in the home?
If yes, please describe:
Please describe any previous experience working with dogs with behavior needs:
What kinds of behaviors? What training methods or behavior modification did you use?
Please Describe any previous experience with caring for dogs with medical issues:
Injections, eye meds, oral meds, SubQ fluids, etc.
Do you rent or own your home? If you rent, please provide your landlord's contact info
Do you have a fenced yard?
Please describe your fencing:
Chainlink? Privacy? Invisible? Approx. size?
Describe your housing type:
Single family home, apartment, duplex, mobile home, etc
How would you describe your neighborhood?
Quiet- little to no traffic and/or pedestrians
Moderately busy- some traffic and/or pedestrians
Busy- frequent traffic and/or pedestrians
Apartment living- may need to pass other dogs in hallway or share elevator
City living- loud noises and traffic
Rural living- I have acreage and can't even see the neighbors!
Do you commit to getting professional training for your new dog?
It can take months to find the right fit, are you up for a long term commitment and seeing things through?
Do you have a trainer in mind? Please list below.
Do you understand that your adopted dog will need time to settle in to your home?
Some of our dogs need time to acclimate and may need to be leashed or separated for an extended period of time while they get used to their surroundings and family members
Do you have any physical, mental, or health conditions that may interfere with your ability to commit to a dog long term?
If yes, and you feel comfortable sharing, please do so here:
Please list the name of your preferred dog, or any size, sex, breed, age preferences here:
Veterinary Reference
*
Please inform your vet we will be calling for a reference
Personal Reference #1
*
Name, email address, phone number, relationship
Personal Reference #2
*
Name, email address, phone number, relationship
Personal Reference #3
*
Name, email address, phone number, relationship
Home Visit Required
I understand that a home visit is required prior to me being approved as an adoptive home, and agree to allow this to take place.
Please type your signature in the box below
I understand that this is a legal representation of my signature
Date
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DD
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