Name of dog you are applying for
Name / Address
Best Phone Number to reach you
Why are you looking for a new pet at this time?
Occupation and work hours for each adult in household:
Do you Own or Rent / please specify - house, apartment, townhouse, condo
If Rent land lord Information
Do you have a yard?
Type and height of fencing
Are there children in the home?
Ages of children / residents in home
Please list other animals in home (Type, breed, age)
Veterinarian name and number
Specific Preferences for dog?
Activities you would like your dog to do with you/your family (please check all that apply):
Relaxing in the evening/company
Playing with kids
Dog sports (agility, flyball, dockdiving, frisbee etc)
What would cause you to return this pet? (check all that apply):
Change in Marital Status
Personal Health Issues (your own or family member)
Health issues (pet)
Not compatible with other pets
Kids not taking care of pet
Does not play ball/catch
Would not return
If no specific dog in mind please fill out the following:
Baby (3 - 4 months)
Young Puppy (4 - 6 months)
Young (6 months to 1.5 years)
A copy of your responses will be emailed to the address you provided.
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