Name of dog or puppy you're interested in adopting *

Your title *

Your first name *

Your middle name/initial

Your last name *

Your home address *

Street name/number, Apartment number

City *

State *

Zip *

Email Address *

Preferred telephone number *

Put your desired phone # for communication. Include area code.

Secondary telephone number *

Include a 2nd phone number to reach you. Include area code.

What other pets do you have? *

Provide the following for each pet living in your home: Name, Type, Age. State NONE if you have no other pets.

What other people live in your household? *

For each person, provide his/her name, relationship to you, ages. State NONE if no one else lives with you.

Do you live in an apartment or house? *
House
Apartment

Do you own or rent? *
Own
Rent

If you rent, provide your landlord's name.

If you rent, provide your landlord's telephone number.

Include area code.

Describe where the pet will be kept during the day and at night. *

During a normal day, how many hours will the pet be unattended (left alone)? *

Do you have a fenced yard? *
Yes
No

Can you afford a pet? *
Yes
No

Consider not only the adoption fee, but the cost of monthly preventatives and annual vet visits (approximately $300 annually).

What behavior traits would absolutely NOT be acceptable to you and would cause you to return a pet? *

Be specific so we can help you make the right adoption choice.

Do you or your family members have allergies? *
Yes
No

Provide the name of a veterinary reference (name of vet and/or name of clinic). *

State NONE if you do not have a vet.

Provide the address of your veterinary reference. *

State NONE if you do not have a vet.

Provide a phone number for your veterinary reference. *

State NONE if you do not have a vet.

List the name(s) of the pet(s) cared for at this vet's office. *

State NONE if you do not have a vet.

Provide the name of a personal reference. *

Provide a telephone number for your personal reference. *

What criteria are you looking for in your adopted pet? *

Be specific.

Tell us a little bit about your past experience with dogs/puppies. *