Name of dog(s) that interest you *
Home Phone # *
Work Phone #
Email Address *
Street Address *
Mailing Address (if different from street address)
City
Province
Postal Code
Occupation
Daily Work Hours
Names and Ages of All Household Members
Who Will be the Primary Care Giver?
What Type of Residence Do You Live In? (house, trailer, etc.)
Approximate Size of Your Yard
If it is fenced, what type of fencing and how high?
If you have no fence, how will you deal with the dogs toilet and exercise needs?
List the type, age and gender of all household pets
Are they spayed / neutered?
If not, please explain
Describe how you think your pets will react to a new dog:
Have your pets been vaccinated in the last 3 years?
Where will the dog spend the day?
Where will the dog spend the night?
How many hours on average will you have to spend with the dog daily?
How many hours will the dog spend alone daily?
What activities will this dog have to do on a daily basis?
What are your plans for the dog? (Agility, Flyball, Obedience, Hunting, Guard work, Search & Rescue, etc)
Are you prepared for shedding, hair, nose prints, and paw tracks throughout your home?
Will you be able to groom the dog?
What will happen to the dog when you go on vacation?
What are your reasons for applying to adopt a dog?
Do you have any other concerns?
Have you adopted companion animals from shelters or rescue groups before?
How many dogs have you owned in the last five years?
If you have pets, who is your veterinarian?
If you have not had a pet recently, have you chosen a veterinarian for this dog?
Reference 1 (include contact info): *
Reference 2 (include contact info): *
Reference 3 (include contact info): *
Where did you hear about us?
