Name of Pet you are
Spouse's or Significant Other Name (if any):
Phone, if any:
Phone, if any:
Spouse's or Significant Other's Age:
other adults live in your home?
their ages, if appl.?
have any children living in your home or visiting your home on a
what are their ages?
If NO, do
you expect that to change in the near future?
anyone in your home have allergies?
of home do you live in?
Do you own
rent, do you have landlord permission to have a pet?
rent, please provide your landlord's name and phone number:
have a securely fenced yard?
of fence do you have?
the height of your fence at the lowest point?
Will you consent to a
home inspection by one of our volunteers?
have plans to move in the near future?:
PET CARE INFORMATION
hours per day will this adopted dog be left alone:
this adopted dog stay during the day?
this adopted dog stay during the evening?
this adopted dog sleep?
adopted dog is not housebroken, how will you manage this?
willing to crate train this adopted dog, if necessary?
willing to attend dog obedient classes, if necessary?
prepared and willing to take care of this adopted dog's needs for his
or her natural lifetime?
have the financial resources to pay for any and all veterinary
medical costs for this adopted dog?
have a limit of how much you are willing to spend?
what is that limit?
If or When
you go on vacation, where will this adopted dog stay?
If you are
unable to keep this adopted dog for any reason, what will you do with
Under what circumstances
would you ever give a dog up?
ever given a pet to a animal shelter, humane society, or rescue
what was the reason for giving that pet up?