Applicant Information |
| * Name: |
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| Street Address: |
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| City: |
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| State/Region: |
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| Zip Code: |
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| * Home
Phone: |
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| Work Phone: |
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| Cell/Fax: |
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| * Email: |
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| Occupation: |
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Household Information
(Spouse/Room-mate/Children) |
| Number of persons in the household: |
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| Number of children (under 16): |
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| Ages of children: |
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| Name of spouse or roommate: |
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| Occupation of spouse or roommate: |
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Residence Information |
| How long at present address: |
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| Do you rent or own: |
Rent
Own |
| Type of residence: |
House
Condo
Apt
Mobile Home
Others, pls indicate:
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Landlord's Name:
(If you rent) |
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Landlord's Phone:
(If you rent) |
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| Type of Fence: |
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| Highest Point: |
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| Lowest Point: |
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| Type of Gate: |
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| Number of Gates: |
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| Height of Gate: |
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| Type of Lock: |
Padlock
Key Entry
Latch
Others, pls indicate:
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| Number of locks: |
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| Is anyone in your household allergic to dogs: |
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Areas Available To The Dog |
| When would the dog be inside: |
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| When would the dog be outside: |
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| In what areas of the house would the dog be allowed: |
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| What outside areas are available to the dog: |
Balcony
Kennel/Run
Covered Patio
Garage
Others, pls indicate:
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| How many hours of the day would the dog be alone: |
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| Do you have a pet door: |
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| Where would the dog sleep at night: |
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Other Pertinent Information |
How do you plan to
provide for your dog when you are out of town:
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What would you do if
you had to move and had trouble finding a place that allowed pets:
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What would happen to
your dog if you had to relocate out of State or overseas:
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Do you have experience with dog obedience training:
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If yes, what experience:
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Would you be willing
to attend obedience classes at your own expense:
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How will you
discipline your dog if it misbehaves:
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What would you do if
the undesirable behavior continued:
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Under what
circumstances would you not keep your dog:
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What would you do in that event:
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Are you prepared for
veterinary expenses such as emergency medical problems,
(especially
in old age), that you will incur when adopting this dog for it?s
entire life:
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Have you ever bred a dog:
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If yes, why:
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If you own a dog or
cat, is it spayed or neutered:
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If not please explain why:
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Do you have a veterinarian:
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Name and City :
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Please indicate all
dogs and cats you have owned, and all pets you currently have.
Indicate the "Type", "How and Why obtained", "How long Owned" and
"What Happened"
to the pets. Under the column ?What Happened? explain if the pet was
lost, given away,
stolen, sold taken to an animal shelter, or died (In which case
state cause of death). |
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Additional Information |
Would you agree to an inspection
of your premises:
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What are your primary reasons for
wanting to adopt a dog:
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