Congratulations

Dog name you are interested in(required)

Full Name (required)

Address(required)

City(required)

Postal Code(required)

Phone(required)

Your Email (required)

Have you adopted from us before (required)

YesNo

If yes who?

Have you ever surrendered or given up an animal? (required)

YesNo

If yes: How long ago, who took your animal and why did you surrender the animal?

Are you 18 years of age or older?(required)

YesNo

Do you have photo ID with proof of age?(required)

YesNo

Do you expect to move within the next 3 years?

YesNo

Are you the homeowner?

YesNo

If no, do you have a permission letter from your landlord?

YesNo

Are all adults in the household in agreement on the adoption of a new pet?

YesNo

Who will be primarily responsible for the pet’s care?(required)

number of adults in household(required)

number and ages of children in household(required)

Does anyone in the household have allergies to animals?

YesNo

How many hours a day are you and your family regularly away from home?(required)

Who will take care of your pet if you cannot (vacation/emergency/illness)? (required)

What circumstances would lead you to return your pet to us? (required)

I am adopting this animal as(required)

Companion for selfCompanion for family (spouse, children)Companion for other petWorking (Herding, hunting, mousing, service, guarding)Other

Have you ever owned a dog before?

YesNo

Current # of dogs in household (required)

Current # of cats in household (required)

Other pets in household (required)

Please provide info on your animals (Breed, Age, Sex, Fixed, Length Owned?) (required)

Do your current pets have microchips/licenses/identification?(required)

YesNo

Are they vaccinated and altered?

YesNo

What size of adult dog would you like?(required)

SmallMediumLarge

When family is not with the dog, I will keep it(required)

Dog run/loose in yardChained in yardBarn/garageLoose in houseLoose on farm/acreageCrated/Room in house

Other?

I plan to keep the dog primarily(required)

OutsideInsideBoth Out and InWith me

Other?

I plan to provide exercise by (required)

Loose in houseLoose in yard/propertyDaily walks on leashJogging/BikingOff-leash parks

Are there any specific activities you would like your dog to participate in (e.g. Jogging, hiking)?(required)

How much money do you think you will need to spend yearly on your pet? (incl. Vet, Food, Supplies)(required)

How often do you expect to visit a veterinarian each year? (required)

Do you have a particular vet clinic in mind? (required)

Do you have any experience in housetraining? (required)

YesNo

Do you have any experience in obedience/pet training? (required)

YesNo

Do you understand that adoption is a lifetime commitment, once you agree to take a dog into your home you are agreeing to care for that animal for the rest of it's life? (required)

YesNo

Do you understand how much time, effort and patience is required for a rescue dog?(required)

YesNo

Do you understand that all of the information about our animals is based on observation within the shelter environment and/or information provided by a third party, and therefore, we cannot guarantee that the breed, age, behavior, or health listed is correct? (required)

YesNo

Additional Comments (recommended)