Home Phone
City, State, Zip

Cell Phone
Work Phone
Email Address
Is there a particular dog you are interested in?  
Name of dog:
Your Information:

Your Ideal Dog:

Energy Level:
Coat Length:
Additional Characteristics:

If Necessary:

Home Environment:

Your New Dog:
Are you willing to provide:
crate training?
obedience training?
Please indicate where you live:
Do you own or rent?
If renting, do you have permission from the landlord to have a pet?
Please provide contact info for property manager:
How long have you lived there?
Any other animals in the home?
If yes, please list type, breed, age, gender?
If Yes, please explain which:
Do you have a yard?
Please list the gender and ages of all residents of your home - including yourself:
If you have to move, what will happen to the dog? 
If yes, what size is it?
Do you have a pool? If so, is it fenced?
Is your yard fully fenced?
If yes, what is the height and material?
house training?
Are they altered?
Who is their current vet?
Have you owned dogs in the past?
If so, what happened to them?
Adopting a dog is a commitment that could last over 10 yrs - are you prepared to take care of a dog for this period? If you cannot, what would you do?
Where will your new dog spend the day?
Will your dog be allowed on the furniture?
How many hours will the dog spend outside/inside?
How many hours will your dog spend without humans?
What and where will be the dogs sleeping area at night AND during the day? Please specify more than "inside/outside"
What activities do you plan for your dog?
If necessary, how do you plan on obedience training your dog?
Will you agree to keep your dog on flea and heartworm preventative?
Are you willing to adopt a dog with a challenging temperament (shy/fearful/active /untrained/fence jumper, dominant, etc)?
Please describe a normal day for your new dog, where they will be, who they might be with, etc
**There must be a comment in every field to successfully submit this form**