Please tell us about your family and living accomodations so we can best recommend a compatible match! You must be at least 18 years old to submit an application.

YOUR NAME:
YOUR EMAIL:
FOSTER PARENT'S NAME: Unknown Ann G. Anne R. Ashley Beth Bill Gayle Jessie Julie Kathy KathyB Melissa Louis Randy Robin Tanya Warren Wendi <= Please select the contact person listed with the animal!
DOGS'S NAME AND BREED THAT YOU ARE INTERESTED IN: OR DESCRIBE WHAT YOU ARE LOOKING FOR? WHERE DID YOU FIRST SEE THIS DOG? (PETFINDER/PETSMART/ADOPT-A-PET/AJC/CRAIGSLIST, ETC.) YOUR STREET ADDRESS: CITY/STATE: HOME PHONE: CELL PHONE: AGE: SPOUSE AGE: OCCUPATIONS OF BOTH: HOW MANY CHILDREN? AGES: OR PLAN ON HAVING CHILDREN SOON? HOW DO YOUR CHILDREN BEHAVE AROUND ANIMALS? TYPE OF RESIDENCE? APT/CONDO/TOWNHOME/TRAILER/FARM/OTHER: OWN or RENT? RURAL/SUBURBAN/URBAN/NO OUTDOOR AREA: SIZE OF LIVING AREA: ARE YOU WILLING TO PERMIT HOMECHECK? DO YOU HAVE A FENCED YARD? IF YES PLEASE DESCRIBE: LEASH WALKS(FREQUENT/OCCASIONAL/NONE): HOW MANY HOURS WILL DOG BE LEFT ALONE? DURING WHAT TIME FRAME? WHERE WILL DOG BE KEPT WHEN HE/SHE IS LEFT ALONE? DURING DAY? DURING NIGHT? WHERE WILL DOG BE WHEN FAMILY IS HOME? IF YOU HAVE A FENCED YARD, KENNEL OR PEN..HOW MUCH TIME WILL DOG BE SPENDING THERE AND UNDER WHAT CONDITIONS WOULD HE/SHE BE LEFT OUTSIDE(DURING WORK HOURS, AT NIGHT, ETC): ARE YOU FAMILIAR WITH AND WILLING TO CRATE TRAIN? DOES ANYONE IN YOUR FAMILY HAVE ALLERGIES TO HAIR,DUST, OR ANIMAL DANDER? DO YOU HAVE ANY EXPERIENCE WITH THIS BREED? (IF MIXED BREED, CHOOSE DOMINANT BREED): CURRENTLY OWN ANY DOGS? IF YES, PROVIDE BREED,SEX,AGE AND CURRENT SPAY/NEUTER STATUS: OWN ANY OTHER TYPES OF PETS? IF YES, PROVIDE TYPE, AGES AND CURRENT SPAY/NEUTER STATUS: HAVE YOU OWNED DOGS IN THE PAST? IF YES, WHAT DID YOU LIKE MOST ABOUT? LEAST? DISPOSITION OF PRIOR DOG(S):(RAN AWAY/STOLEN/SOLD/GIVEN AWAY/GIVEN UP TO RESCUE ORGANIZATION/GIVEN UP TO ANIMAL CONTROL/EUTHANIZED/DIED: IF GIVEN UP, WHY? IF EUTHANIZED, WHY? IF DIED, CAUSE OF DEATH? VET REFERENCE: DOG TRAINER(IF ANY) NAME & PH# SOME RESCUES HAVE PRE-EXISTING HEALTH CONDITIONS/HEALTH PROBLEMS THAT MAY REQUIRE FURTHER CARE BY ADOPTER (I.E. ALLERGIES,HIP DYSPLASIA,DRY EYE,IMPAIRED VISION/HEARING) WOULD YOU ADOPT A DOG THAT HAS EXISTING HEALTH PROBLEMS? ARE YOU WILLING TO TRAVEL TO PICK UP YOUR DOG? ARE YOU AWARE OF THE FOLLOWING COSTS OF MAINTAINING A HEALTHY DOG? (I.E. ANNUAL VET CHECKS & VACCINES, HEARTWORM & FLEA PREVENTATIVE, FOOD, TREATS, DENTAL CARE, ACCESSORIES(LEASH,COLLAR,BED,ETC) UNFORSEEN ACCIDENTS/ILLNESSES) UPON ADOPTION, IT IS A REQUIREMENT THAT THE DOG BE KEPT UP ON ALL VACCINES AND PREVENTATIVES, HEALTHY AND IN A SAFE/LOVING HOME. ARE YOU PREPARED TO MEET THESE REQUIREMENTS? ARE YOU PREPARED TO SIGN A CONTRACT AGREEING TO THESE REQUIREMENTS? ARE YOU AWARE THAT IF THESE REQUIREMENTS ARE NOT MET, WE RESERVE THE RIGHT TO CONFISCATE THE DOG? DO YOU AGREE THAT IF AT ANYTIME YOU CANNOT KEEP THIS DOG OR WISH TO GIVE DOG UP, YOU MUST FIRST CONTACT US. ANYTHING ELSE WE NEED TO KNOW: SIGNATURE (TYPE YOUR NAME) THANK YOU!