Adoption Application

Please take a moment to tell us a little about yourself so that we can help you make the best match possible.

Name *
Address *
AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Email *
Email (again for verification) *
Home Information
Do you rent or own your home?
OwnRent
If you rent, please provide the name, email, and/or phone number of your landlord
Are you over 21?
YesNo
Are you employed?
YesNo
How many adults reside in your home?
Please list the ages of each child in your home:
On a typical day, how long will this dog or puppy be alone?
Where will he/she be left when you are not there?
Is your yard entirely and securely fenced?
YesNo
If your yard is not fenced, have you considered a safe way to confine the dog when you are outside?
Would you still be able to care for this dog if your home or family situation changed (divorce, relocation, baby)?
YesNoUnsure
Please explain your answer above:
Other Pets
Do you currently own any other pets?
YesNo
If so, are they all spayed / neutered and medically up to date?
YesNo
If not, why?
List names, breed, age and sex of each of your current pets (cats, dogs, etc.):
What happened to the last pet(s) in your care?
What are you looking for?
Did you see a particular dog or puppy(s) on the website that interested you? Who: *
How would you describe your lifestyle?
HomebodyActive OutdoorsRunning the children from event to eventHave lots of visitorsWorkaholicHardly ever home
Other / more details:
What are your preferences for activity level?
Atheltic / high energyLap dogMellowAffectionateActive outdoors
Other / more detail:
What are your preferences for age and sex?
BabyYoung AdultAdultSeniorMaleFemale
Please tell us about your family and dog experience:
What circumstances would be cause for you to surrender your dog? Please be specific:
Are you aware that most shelter animals have unknown backgrounds and that while we do our best to guess at breed/ age/ temperament we can not be sure of these items? *
YesNo
Are you aware of the time and financial commitment a dog will require (obedience classes, supplies, vet bills, food, dog walkers/sitters etc? *
YesNo
What do you estimate to be the annual cost of owning a pet (not including emergencies)? *
Previous Adoptions
Have you ever adopted from a Humane Society / Rescue before?
YesNo
If so, how long ago?
Have you ever surrendered an animal you owned to a Humane Society?
YesNo
If yes, what were the circumstances?
References
Vet
Reference *Name and phone or email REQUIRED
Other Information
I agree to the $400 adoption fee *
Our adoption fee of $400 includes: Health examination(s), Spaying/Neutering, 30 days of FREE Pet Health Insurance, Wormings (age related), Distemper Combo Vaccination (number of vaccinations will be related to age), Rabies Vaccination (If older than 4 months when adopted), Heartworm Disease Test (If older than 6 months when adopted), Flea & Tick Treatment. In addition, most (not all) of our animals are microchipped and we provide FREE registration for one year through 24 Hour Pet Watch. Yes
Is there any additional information you would like us to know or questions you need answered?
Thank you!

Verification

Please enter any two digits with no spaces (Example: 12) *
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