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Adopt
Donate
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Newsletter Posts
Contact Us
Dog Adoption Application
Name of Dog
Description of Dog
Age Range of Dog Preferred?
*
Gender of Dog
*
Female
Male
Undecided
About You
Your First Name
*
Your Last Name
*
Email Address
*
Primary Phone
*
Secondary Phone
Age
*
Select
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
Option 83
Option 84
Option 87
Option 88
Other
Age
Street Address
*
City
*
State
*
California
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Alabama
Alaska
Arizona
Arkansas
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Your Occupation
*
Spouse/Partner Name or N/A
*
Spouse/Partner Occupation or N/A
*
Who will be responsible for daily care of this dog?
*
Why do you want a dog?
*
Companion for me
Child wants a pet or companion for another pet
Certification as a therapy dog
Hunting or guard dog
Other
If other, please explain:
Household Info
Number of Persons in Household
*
1
2
3
4
5
6
7
8
9
10
More than 10
Number of Children under 16:
*
0
1
2
4
5
6
7
8
9
10
More than 10
Ages of children in household or N/A:
*
If you have children, have they been around dogs before?
*
Yes
No
List Pets in Home: Name, Age, Type/Breed, Number
*
Name & City of Current Vet:
*
Residence Info
Residence Type
*
Select
House
Townhouse
Apartment
Mobile Home
Other
Residence Type
Rent or Own?
*
Rent
Own
Landlord's Name & Phone Number
*
Length of time at current address?
*
Under 6 months
6-11 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
Over 7 years
This dog will be:
*
Indoors Only
Mostly Indoors
Outdoor Days, Indoor Nights
Mostly Outdoors
Outdoors Only
Where will the dog be when you aren't home:
*
Outside in the yard
Loose in the house
In a single room
In a crate
None of the Above
How many hours a day will the dog be alone:
*
Less than 4 hours
4 to 8 hours
9 or more hours
Location of dog's bed? Where will the dog sleep at night?
*
Do you have a dog/cat door?
*
No
Yes
Is yard fenced? Fence Height? Fencing Materials?
*
What will happen to your dog when you're out of town?
*
Can you afford regular veterinary care--including annual physical exams, vaccinations, dental care, etc? ($300 to $500 or more per year)?
*
No
Yes
For what reason(s) would you give up the dog?
*
New baby
Moving
Illness
Divorce/Separation
Unemployment
Not getting along with other pets
None
Other
If other, please explain:
What would you do if...
Who would take the dog if your relationship changed?
*
had to move & had trouble finding a place that allowed pets?
*
if you had to relocate out of state or overseas?
*
Are you satisfied that a volunteer could help you if these issues occur?
*
Yes
No or Not Sure
May we contact you in the future to check on your new dog?
*
Yes
No
If no, why not?
Have you ever owned dogs before?
*
Yes
No
If yes, what happened to them?
If yes, what happened to them?
Will you keep a collar with ID tags on this dog at all times?
*
Yes
No
If you had a previous pet put to sleep, what source did you use?
*
Vet
Shelter
What were the circumstances?
Have you ever bred a dog or cat?
*
Yes
No
If yes, what type was it?
Are other dogs in your home fixed?
Yes
No
PLEASE READ CAREFULLY: It is a major commitment to adopt any pet. Please remember that DOGS CAN LIVE FOR OVER 17 YEARS. Thousands of dogs are killed at animal shelters each year because their owners didn't plan for the future. Dogs can get sick & require expensive medical treatment during their lives. Dogs need affection, attention & understanding. You may have to adjust your lifestyle for your new pet. CHECK HERE IF YOU ARE READY TO MAKE THIS COMMITMENT.
*
I Agree