We reserve the right to deny adoptions, to conduct pre- and post-adoption phone checks and/or to visit your home to see that the needs of the adoptive animal will be met.

Dog
Which of our dogs are you interested in?	Not certain yet Apollo Grant Henry Mocha Rizzo Sophie Sprite
Primary Applicant Information
Name:
Age:	21 or over 20 19 18 17 16
Street address:
City / State / ZIP:
Home phone:
Work phone:
Cell phone:
Email:
Current employer:
How long at current employer?
Co-Applicant Information (if applicable)
Name:
Age:	21 or over 20 19 18 17 16
Work phone:
Cell phone:
Email:
Current employer:
How long at current employer?
Information About Your Home
Type of home:	Apartment Single-Family House Duplex Condo
Landlord's name & phone:	(If you rent, we must consult your landlord prior to adoption)
Type of neighborhood:	Urban Suburban Rural
Type of fencing:	Wood Chain Link Other   A fenced yard is required.
If Other, please explain:
Is your yard fenced on all sides?	Yes No
Size of yard:
Do you have a pool?	Yes No
Is it inside its own separate fence within a fenced yard?	Yes No
Is anyone in your household allergic to animals?	Yes No
Number and ages of children in your household:
Are all family members aware of and in agreement with your adoption of a rescue dog?	Yes No
References (2 references are required)
Name:
Relationship:
Phone:
Name:
Relationship:
Phone:
Your Pet History
Have you lost a pet recently?	Yes No
How?
Have you had to give a pet away?	Yes No
Why?
Did you find the pet another home?	Yes No
Current Pet Information
Do you own pets now?	Yes No
What kind?
What are their names?
Are they vaccinated?	Yes No
Are they spayed/neutered?	Yes No
Do you have ID on your pets?	Yes No
What type of heartworm prevention do you use?
Do you have a dog house?	Yes No
Do you have a kennel?	Yes No
Do you have a preferred veterinarian/clinic?	Yes No
Name of your veterinarian and clinic:
Do you get all your pet services there?	Yes No
If No, where else do you go?
Your Pet Preferences
Breed:
Age:
Color:
Gender:	Male Female Either
Will this pet be a gift?	Yes No
For whom?
This pet will be kept:	Indoors Outdoors Both
Will you place ID on this pet?	Yes No
Will this pet be alone during the day?	Yes No
For how long each day?
Do you have any problems with us contacting you in the future to check on the adopted pet?	Yes No
Why do you want to adopt a pet?
Please tell us about your expectations in adopting a pet:
Please tell us any concerns you have in adopting a pet:
Additional comments: