Name of Pet you are interested in:
Last Name
First Name
Address
City/State/Zip code
Email Addess
Home Phone
Work Phone
Cell Phone
Number of People in Household Adults Ages of children
Children
Complete names of adults living in household
Who will be the primary caretaker for this pet?
Type of home
House
Townhouse
Apartment/condo
Do you
Own
Rent Are you planning on moving in the next six months?
Do you have a securely fenced Yard?
If so, What type of fence, and how tall is the fence?
Do you have a doggy door? Yes
No Are you planning on getting a doggy door?
Yes
No
If you rent, list your landlords or rental agents:
Phone Number
Name
Please list all animals that currently reside with you:
Spayed Owned for
Where did you
Pets Name
Type/Breed
Please list all companion animals you have owned in the past 10 years, starting with the most recent. If you have had
Where did Why is this pet
Owned for
When did
Spayed
Pets Name
Type/Breed
Do you have a Veterinarian?
Clinic or hospital name
Phone number
Have you ever Crate Trained a dog before? Have you ever House Trained a dog before?
Have you ever Obedience Trained a dog before?
Will you take this dog to obedience classes?
Where will the dog be kept..
During the day?
Indoors
Outdoors
In crate Other
At Night? In crate
Outdoors
Indoors Other
While you are not at home? Indoors
Outdoors In crate Other
When you are on vacation?
Would you like this pet to be primarily:
An indoor dog
An outdoor dog
How long will this pet be left alone each day?
Do you plan on crating this dog?
If so, how long?
Are you able to provide a mid-day walk? How much does a doggy walker cost, per day?
Veterinary:
How much do you think it costs ANNUALLY to own a dog?
Food, supplies, etc:
What kind of animal behavior do you feel unable to accept?
What will you do if the pet begins to exhibit these behaviors?
What will you do if you have to move unexpectedly?
Does anyone in the household have allergies?
A new pet may take several months to adjust to his/her new home. How will you help with this adjustment?
Why do you want to adopt a dog?
What type of coat are you looking for?
Short
Medium Long
Is someone in your household willing to brush the dog regularly?
Yes
No
How much does it cost to have a pet groomed?
Are you willing to have this dog professionally groomed on a regular basis?
Yes No
Activity level in a dog most appeals to you?
Low
Medium High
Lap dog Game player Agility
Adaptability Obedience
What are you looking for in a dog?
Low maintenance Companionship
Good with other animals
Social butterfly Good with children
Other, please explain
Completely trained dog
Will the dog be used for guard purposes?
Will you chain or tether the dog outside?
Is someone in the household willing to exercise this pet every day?
If so, who?
How are you planning to exercise this dog?
Will you let the dog off leash in an unconfined area?
How much time do you have to exercise a pet each day?
Have you ever had to give a pet up (dog/cat/other) for any reason?
No
Yes
If yes, what happened to the pet? (Ex. Took to the shelter, found pet a new home).
What would cause you to return this pet? Please check all that apply:
If my work schedule changed and I didn't have sufficient time for the dog.
If I have children in the future and no longer have sufficient time for the dog because of the
If someone in the household becomes allergic.
If I become ill and can no longer take care of the dog.
If I divorced or separate from my spouse/partner.
If my new significant other/spouse doesn't like the dog.
If I lost my job. If the dog is not housebroken.
If the dog sheds excessively.
If the dog became aggressive.
Other:
**If you are applying for a dog that is seven months or older, you may skip the
**Puppies grow, what sized dog are you looking for as an adult?
**Weight limit?
**Please explain the experience you have raising a puppy to adulthood:
**If you have raised a puppy to adulthood, did you ever have to deal with behavioral issues (ex.
Yes No
If yes, please explain the issue(s), and how you delt with them.
**Please explain how you plan to properly socialize this puppy:
**How will you prevent/manage inappropriate behavior?
**How do you plan to housebreak this puppy?
**Where do you plan to keep this puppy while housebreaking?
**What do you for see as normal puppy problems?
** How will you encourage appropriate behavior?
How did you hear about the shelter?
Do you have any additional comments?
Please review your answers; missing or unclear information will delay or
By checking the button to the right, you are attesting and
